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根治性放化疗联合西妥昔单抗治疗食管鳞癌的疗效可观。

Promising outcomes of definitive chemoradiation and cetuximab for patients with esophageal squamous cell carcinoma.

机构信息

Division of Radiation Oncology, Henan Tumor Hospital, Zhengzhou University Affiliated Tumor Hospital, Zhengzhou, China.

出版信息

Cancer Sci. 2012 Nov;103(11):1979-84. doi: 10.1111/j.1349-7006.2012.02393.x. Epub 2012 Sep 14.

Abstract

This study investigated cetuximab added to definitive concurrent chemoradiation for esophageal squamous cell carcinoma (ESCC). Previously untreated patients with stage II-IVa ESCC received cetuximab (400 mg/m(2) per week in week 1, then 250 mg/m(2) per week during weeks 2-8), paclitaxel (45 mg/m(2) per week) and cisplatin (20 mg/m(2) per week) in weeks 2-8 with 59.4 Gy radiotherapy. Epidermal growth factor receptor (EGFR) status in tumor specimens was assessed. Thirty-one patients were enrolled and evaluated for toxicity. Of the 29 patients assessable for a response, 20 (69.0%) had a clinical complete response (CR). Over a median follow up of 23.6 months, disease progression was observed in seven patients. The 1- and 2-year progression-free survival (PFS) rates were 85.5% and 75.1%, respectively. The PFS was shorter for patients with lymphatic metastatic disease than for those with locally confined tumor; the 1-year PFS rates were 78.7% and 92.3%, respectively (P = 0.038). Sixteen (55.2%) patients were immunohistochemically positive for EGFR. The patients with EGFR-expressing tumor had a CR rate of 75.0% compared with 61.5% in those with negative EGFR expression (P = 0.024). The PFS for patients with EGFR-expressing tumor was longer compared with the PFS of patients with negative EGFR (P = 0.133). The patients with prominent cetuximab-induced rash (≥grade 2) had a better CR rate and PFS than those with no or grade 1 rash (P < 0.05). The rates of grades 3/4 esophagitis, hematological and dermatological toxicities were 9.7%, 29.0% and 16.1%, respectively. The regimen of definitive chemoradiation plus cetuximab achieved good clinical response and has an acceptable safety profile in Chinese ESCC patients.

摘要

本研究探讨了西妥昔单抗联合放化疗治疗食管鳞癌(ESCC)的效果。入组的未经治疗的 II-IVa 期 ESCC 患者接受西妥昔单抗(第 1 周 400mg/m2,之后每周 250mg/m2)、紫杉醇(45mg/m2)和顺铂(20mg/m2)联合放疗(第 2-8 周,59.4Gy)。评估肿瘤标本中的表皮生长因子受体(EGFR)状态。31 例患者入组并进行毒性评估。29 例可评估疗效的患者中,20 例(69.0%)达到临床完全缓解(CR)。中位随访 23.6 个月后,7 例患者出现疾病进展。1 年和 2 年无进展生存率(PFS)分别为 85.5%和 75.1%。有淋巴转移的患者 PFS 短于局部局限肿瘤的患者;1 年 PFS 率分别为 78.7%和 92.3%(P=0.038)。16 例(55.2%)患者 EGFR 免疫组化阳性。EGFR 阳性肿瘤患者的 CR 率为 75.0%,而 EGFR 阴性患者的 CR 率为 61.5%(P=0.024)。EGFR 阳性肿瘤患者的 PFS 长于 EGFR 阴性患者(P=0.133)。出现明显西妥昔单抗诱导皮疹(≥2 级)的患者 CR 率和 PFS 优于无皮疹或 1 级皮疹的患者(P<0.05)。3/4 级食管炎、血液学和皮肤毒性的发生率分别为 9.7%、29.0%和 16.1%。放化疗联合西妥昔单抗的方案在中国 ESCC 患者中取得了良好的临床缓解效果,且安全性可接受。

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