Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy.
Cancer Chemother Pharmacol. 2011 Nov;68(5):1207-13. doi: 10.1007/s00280-011-1604-1. Epub 2011 Mar 16.
Patients with metastatic colorectal cancer (mCRC) receiving all three active drugs (irinotecan, oxaliplatin, fluorouracil) achieve the best outcome. Bevacizumab added to chemotherapy further improves progression-free (PFS) survival and overall survival. As arterial hypertension has been reported in all studies involving bevacizumab, we retrospectively analysed the correlation between the modifications of arterial blood pressure and response rate (RR) and PFS in mCRC patients treated with bevacizumab.
Patients with histologically proven mCRC receiving a first-line chemotherapeutic treatment were eligible. Arterial blood pressure was measured daily and hypertension graduated according to NCI-CTC V3.0 scale.
Seventy-four patients were considered for the present analysis; median age was 57 years (range 31-80). Sixty-seven patients had undergone surgery on primary tumour and, of these, 19 patients had formerly received adjuvant chemotherapy for stage II-III tumours. Chemotherapeutic regimens for metastatic disease were FOLFIRI (61 patients), FOLFOXIRI (6 patients), XELOX (5 patients) and XELIRI (2 patients). Eighteen patients (24.3%) had basal hypertension. Thirteen patients (17.6%) developed G2-G4 arterial hypertension. Six complete (8.1%) and 31 partial (41.9%) responses were recorded. Among patients with induced arterial hypertension, 84.6% achieved a complete or partial response, as compared with 42.6% of patients who did not show this side effect (P = 0.006). Kaplan-Meier analysis showed a statistically significant improvement in median PFS for patients with induced arterial hypertension (15.1 vs. 8.3 months, P = 0.04).
Our data suggest that bevacizumab-related arterial hypertension may represent a predictive factor of response and prolonged PFS in patients with mCRC receiving first-line bevacizumab.
接受所有三种活性药物（伊立替康、奥沙利铂、氟尿嘧啶）治疗的转移性结直肠癌（mCRC）患者获得最佳疗效。贝伐珠单抗联合化疗进一步提高了无进展生存期（PFS）和总生存期。由于所有涉及贝伐珠单抗的研究均报告了动脉高血压，我们回顾性分析了 mCRC 患者接受贝伐珠单抗治疗时动脉血压变化与缓解率（RR）和 PFS 的相关性。
组织学证实的 mCRC 患者接受一线化疗治疗有资格入组。每天测量动脉血压，并根据 NCI-CTC V3.0 量表分级高血压。
74 例患者符合本分析条件；中位年龄为 57 岁（范围 31-80 岁）。67 例患者接受了原发肿瘤手术，其中 19 例患者曾接受过 II-III 期肿瘤的辅助化疗。转移性疾病的化疗方案为 FOLFIRI（61 例）、FOLFOXIRI（6 例）、XELOX（5 例）和 XELIRI（2 例）。18 例（24.3%）患者有基础高血压。13 例（17.6%）患者发生 G2-G4 级动脉高血压。记录到 6 例完全（8.1%）和 31 例部分（41.9%）缓解。在发生动脉高血压的患者中，84.6%达到完全或部分缓解，而未出现这种副作用的患者为 42.6%（P=0.006）。Kaplan-Meier 分析显示，发生贝伐珠单抗相关动脉高血压的患者中位 PFS 有显著改善（15.1 与 8.3 个月，P=0.04）。
我们的数据表明，mCRC 患者接受一线贝伐珠单抗治疗时，贝伐珠单抗相关的动脉高血压可能是反应和延长 PFS 的预测因素。
