Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-0011, Japan.
Int J Clin Oncol. 2011 Aug;16(4):416-20. doi: 10.1007/s10147-011-0216-4. Epub 2011 Mar 26.
The efficacy and safety of cetuximab for irinotecan-intolerant patients has not yet been evaluated in detail.
We retrospectively analyzed the efficacy and safety of cetuximab monotherapy for patients with metastatic colorectal cancer (MCRC) that was intolerant to irinotecan.
Among 105 patients who received cetuximab-containing chemotherapy until March 2010, 22 patients were treated with cetuximab monotherapy due to irinotecan intolerance. Cetuximab was given at the approved dosage to all patients. The performance status was 2 or 3 in 17 patients (77%). All but 1 patient had wild-type KRAS tumors. The causes of irinotecan intolerance were icterus (n = 9; 41%; median serum total bilirubin, 6.3 mg/dl), symptomatic peritoneal metastasis or obstruction (n = 8; 36%), and thrombocytopenia (n = 1; 5%). Four patients (18%) refused irinotecan due to previous irinotecan-associated toxicity. Two patients achieved a partial response with an apparent drop of serum bilirubin, for a response rate of 9.1%. The median progression-free survival and overall survival were 1.6 and 3.5 months, respectively. No grade 3 or 4 adverse events or treatment-related deaths were experienced.
Cetuximab monotherapy for irinotecan-intolerant MCRC is feasible. However, the overall efficacy was modest in the present cohort, despite the fact that most of the patients had wild-type KRAS tumors; further effective therapies should be evaluated to improve the prognosis of this patient population.
西妥昔单抗在不耐受伊立替康的患者中的疗效和安全性尚未得到详细评估。
我们回顾性分析了不耐受伊立替康的转移性结直肠癌（MCRC）患者接受西妥昔单抗单药治疗的疗效和安全性。
在 2010 年 3 月之前接受含西妥昔单抗化疗的 105 例患者中，有 22 例因不耐受伊立替康而接受西妥昔单抗单药治疗。所有患者均按批准剂量使用西妥昔单抗。17 例患者（77%）的体力状况为 2 或 3 级。除 1 例外，所有患者的肿瘤均为 KRAS 野生型。不耐受伊立替康的原因包括黄疸（9 例，41%；中位血清总胆红素 6.3mg/dl）、有症状的腹膜转移或梗阻（8 例，36%）和血小板减少（1 例，5%）。由于先前伊立替康相关毒性，4 例（18%）患者拒绝使用伊立替康。2 例患者的血清胆红素明显下降，获得部分缓解，缓解率为 9.1%。中位无进展生存期和总生存期分别为 1.6 个月和 3.5 个月。未发生 3 级或 4 级不良事件或与治疗相关的死亡。
对于不耐受伊立替康的 MCRC 患者，西妥昔单抗单药治疗是可行的。然而，尽管本队列中的大多数患者都为 KRAS 野生型，但总体疗效并不理想；应进一步评估有效的治疗方法以改善该患者人群的预后。
