贝伐珠单抗治疗转移性结直肠癌后使用西妥昔单抗：这是最佳顺序吗？
Cetuximab after bevacizumab in metastatic colorectal cancer: is it the best sequence?
机构信息
Assistance Publique - Hôpitaux de Marseille, Service d'Oncologie Digestive Hôpital Timone, Université de la Méditerranée, Marseille, France.
出版信息
Dig Liver Dis. 2011 Nov;43(11):917-9. doi: 10.1016/j.dld.2011.06.002. Epub 2011 Jul 16.
BACKGROUND
Chemotherapy combinations and addition of cetuximab or bevacizumab to chemotherapy have been shown to improve overall survival of metastatic colorectal cancer (CRC) patients. However, the efficacy of cetuximab when administered after bevacizumab failure is still unknown.
METHODS
Fifty-eight consecutive patients diagnosed with advanced colorectal cancer between treated with cetuximab following irinotecan failure were included in our analysis. A multivariate Cox model analysis was performed to estimate the effect of previous bevacizumab regimen on survival.
RESULTS
Thirteen (22.4%) were pre-treated with anti-VEGF agents. None of them responded to cetuximab, and this subgroup presented a significantly decreased disease-specific survival as compared to treatment-naïve patients (9.1 months vs. 4.9 months; p=0.026). This difference remained statistically significant in a multivariate Cox model after adjusting for age, sex, performance status (PS), and K-RAS status (RR=2.2; 95% CI: 1.1-4.5, p=0.03).
CONCLUSION
These study results suggest that a previous anti-VEGF therapy decrease cetuximab efficiency.
背景
化疗联合方案以及西妥昔单抗或贝伐珠单抗联合化疗已被证实可改善转移性结直肠癌（CRC）患者的总生存期。然而，贝伐珠单抗治疗失败后应用西妥昔单抗的疗效仍不清楚。
方法
我们对 58 例接受伊立替康治疗后应用西妥昔单抗治疗的晚期结直肠癌患者进行了分析。采用多变量 Cox 模型分析评估既往贝伐珠单抗方案对生存的影响。
结果
13 例（22.4%）患者曾接受过抗 VEGF 药物治疗。他们均对西妥昔单抗无反应，与初治患者相比，该亚组的疾病特异性生存率显著降低（9.1 个月 vs. 4.9 个月；p=0.026）。在调整年龄、性别、体能状态（PS）和 K-RAS 状态后，多变量 Cox 模型仍显示出统计学意义（RR=2.2；95% CI：1.1-4.5，p=0.03）。
结论
这些研究结果表明，既往抗 VEGF 治疗会降低西妥昔单抗的疗效。
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