Gastrointestinal Malignancies Service, Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; ; Department of Gastroenterology, Digestive Oncology Unit, University Hospitals Leuven, Leuven, Belgium;
Onco Targets Ther. 2013;6:53-8. doi: 10.2147/OTT.S41383. Epub 2013 Jan 25.
The combination of chemotherapy and bevacizumab, a monoclonal antibody targeting the vascular endothelial growth factor, is consistently being used as first- and second-line treatment in patients with metastatic colorectal cancer (mCRC). There is little data of the activity of bevacizumab in chemorefractory mCRC patients. The aim of this retrospective single center study was to evaluate the activity of bevacizumab combined with chemotherapy in this study population.
Forty-six consecutive mCRC patients treated in the University Hospital Gasthuisberg (Leuven, Belgium) receiving bevacizumab in advanced lines following failure of conventional chemotherapy were included in this study. Treatment regimen consisted of bevacizumab 5 mg/kg in combination with leucovorin, 5-fluorouracil, and oxaliplatin (FOLFOX) or leucovorin, 5-fluorouracil, and irinotecan (FOLFIRI).
Bevacizumab plus chemotherapy was used in third-line treatment in eight (17%) patients and in fourth-line treatment or more in 38 patients (83%). All patients previously failed irinotecan-based chemotherapy, 44 (96%) failed oxaliplatin-based regimens, and 40 (87%) failed treatment with cetuximab. Bevacizumab was given in combination with irinotecan-based chemotherapy in 36 patients, oxaliplatin-based chemotherapy in nine patients, and with single agent 5-fluorouracil in one patient. Objective response was demonstrated in ten patients (22%) and disease control in 38 (83%) with a median progression-free survival of 8.9 months and a median overall survival of 13.8 months. Only four patients experienced grade III and above bevacizumab-related toxicity.
Taking into account the retrospective nature of the study which can influence the selection of patients, bevacizumab given in advanced lines after failure of conventional chemotherapy and antiepidermal growth factor receptor agents can result in high disease control rates in patients with mCRC.
化疗联合贝伐珠单抗（一种针对血管内皮生长因子的单克隆抗体）作为转移性结直肠癌（mCRC）患者的一线和二线治疗方案被广泛应用。在化疗耐药的 mCRC 患者中，贝伐珠单抗的疗效数据较少。本回顾性单中心研究旨在评估贝伐珠单抗联合化疗在该人群中的疗效。
本研究纳入了在比利时鲁汶大学医院（Gasthuisberg University Hospital）接受贝伐珠单抗治疗的 46 例 mCRC 患者。这些患者在常规化疗失败后，在晚期线接受了贝伐珠单抗治疗。治疗方案为贝伐珠单抗 5mg/kg 联合亚叶酸钙、5-氟尿嘧啶和奥沙利铂（FOLFOX）或亚叶酸钙、5-氟尿嘧啶和伊立替康（FOLFIRI）。
8 例（17%）患者在三线治疗中使用贝伐珠单抗联合化疗，38 例（83%）患者在四线或以上治疗中使用。所有患者均曾接受伊立替康为基础的化疗方案治疗失败，44 例（96%）患者曾接受奥沙利铂为基础的化疗方案治疗失败，40 例（87%）患者曾接受西妥昔单抗治疗失败。贝伐珠单抗联合伊立替康为基础的化疗方案用于 36 例患者，联合奥沙利铂为基础的化疗方案用于 9 例患者，单药 5-氟尿嘧啶用于 1 例患者。10 例患者（22%）有客观缓解，38 例患者（83%）疾病控制，中位无进展生存期为 8.9 个月，中位总生存期为 13.8 个月。只有 4 例患者出现 3 级及以上的贝伐珠单抗相关毒性。
考虑到该研究为回顾性研究，可能会影响患者的选择，因此，在常规化疗和抗表皮生长因子受体药物治疗失败后，在晚期线使用贝伐珠单抗可以使 mCRC 患者获得较高的疾病控制率。
