Yang Yuan-Hao, Lin Jen-Kou, Chen Wei-Shone, Lin Tzu-Chen, Yang Shung-Haur, Jiang Jeng-Kai, Lan Yuan-Tzu, Lin Chun-Chi, Yen Chueh-Chuan, Tzeng Cheng-Hwai, Teng Hao-Wei
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan.
J Cancer Res Clin Oncol. 2014 Nov;140(11):1927-36. doi: 10.1007/s00432-014-1741-0. Epub 2014 Jun 17.
We aimed to compare the treatment efficacy of cetuximab versus bevacizumab in combination with either irinotecan-based or oxaliplatin-based regimens (targeted triplet) as the first-line treatment for patients with metastatic colorectal cancer.
Between April 2005 and March 2012, patients (n = 158) diagnosed with metastatic colorectal cancer after at least four courses of first-line bevacizumab-based (n = 95) or cetuximab-based triplet (n = 63) were retrospectively analyzed. The KRAS genotypes were sequenced for all patients. The Kaplan-Meier method was used for survival analysis, and Cox proportional hazards models were used for univariate and multivariate analyses.
Cetuximab-based triplet was associated with a higher objective response rate (66.0 vs. 47.2 %, p = 0.037) and a higher conversion rate to resectability (39.7 vs. 20.0 %, p = 0.007) compared to bevacizumab-based triplet. Compared with bevacizumab-based triplet, cetuximab-based triplet significantly increased progression-free survival in patients with measurable metastatic colorectal cancer who achieved objective tumor response (responders) (median 13.1 vs. 10.5 months, p = 0.023), but no significant increase was observed for overall survival. After adjustment for group differences in baseline characteristics and combined chemotherapy agents, cetuximab-based triplet remained an independent determinant of progression-free survival in responders as compared with bevacizumab-based triplet. KRAS mutation was not a prognostic factor in patients with metastatic colorectal cancer.
As compared with bevacizumab-based triplet, cetuximab-based triplet as the first-line treatment of metastatic colorectal cancer was associated with better progression-free survival in patients with measurable tumors who achieved objective tumor response to bio-chemotherapy.
我们旨在比较西妥昔单抗与贝伐单抗联合基于伊立替康或基于奥沙利铂的方案（靶向三联疗法）作为转移性结直肠癌患者一线治疗的疗效。
回顾性分析2005年4月至2012年3月期间诊断为转移性结直肠癌的患者（n = 158），这些患者在至少四个疗程的一线基于贝伐单抗（n = 95）或基于西妥昔单抗的三联疗法（n = 63）治疗后接受分析。对所有患者进行KRAS基因分型测序。采用Kaplan-Meier法进行生存分析，Cox比例风险模型用于单因素和多因素分析。
与基于贝伐单抗的三联疗法相比，基于西妥昔单抗的三联疗法具有更高的客观缓解率（66.0% 对47.2%，p = 0.037）和更高的可切除性转化率（39.7% 对20.0%，p = 0.007）。与基于贝伐单抗的三联疗法相比，基于西妥昔单抗的三联疗法显著提高了达到客观肿瘤缓解（缓解者）的可测量转移性结直肠癌患者的无进展生存期（中位值13.1个月对10.5个月，p = 0.023），但总生存期未观察到显著增加。在调整基线特征和联合化疗药物的组间差异后，与基于贝伐单抗的三联疗法相比，基于西妥昔单抗的三联疗法仍是缓解者无进展生存期的独立决定因素。KRAS突变不是转移性结直肠癌患者的预后因素。
与基于贝伐单抗的三联疗法相比，基于西妥昔单抗的三联疗法作为转移性结直肠癌的一线治疗，在对生物化疗达到客观肿瘤缓解的可测量肿瘤患者中，与更好的无进展生存期相关。
