Division of Radiation Oncology, Henan Tumor Hospital, Zhengzhou University Affiliated Tumor Hospital, Zhengzhou, China.
Cancer Sci. 2012 Nov;103(11):1979-84. doi: 10.1111/j.1349-7006.2012.02393.x. Epub 2012 Sep 14.
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.
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。