Bruera Gemma, Russo Antonio, Galvano Antonio, Rizzo Sergio, Ricevuto Enrico
Oncology Territorial Care, S. Salvatore Hospital, Oncology Network ASL1 Abruzzo, University of L'Aquila, L'Aquila, Italy.
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Oncotarget. 2017 Jun 6;8(23):37875-37883. doi: 10.18632/oncotarget.14333.
Bevacizumab addiction to triplet chemotherapy, according to FIr-B/FOx schedule, as first-line treatment in young-elderly metastatic colorectal CANCER (MCRC) patients may be more effective. Tailored treatments show worse clinical outcome in unfit patients.
Elderly patients were clinically evaluated according to age and comorbidity (Cumulative Illness Rating Scale) to select FIr-B/FOx regimen in fit or tailored treatments in unfit elderly. Limiting toxicity syndromes (LTS) were evaluated.
At 17 months follow-up, in 28 young-elderly patients treated with first line FIr-B/FOx: objective response rate (ORR) 79%, progression-free survival (PFS) 11 months, overall survival (OS) 21 months. Clinical outcome was not significantly different according to KRAS genotype. G3-4 toxicities were diarrhea 21%, mucositis 11%, neutropenia 11%. LTS were 46%, significantly more multiple than single site. At 8 months follow-up, in 37 unfit patients: ORR 37%, PFS 7 months, OS 13 months. PFS was significantly different in KRAS wild-type compared to mutant patients, while not OS. PFS and OS were significantly worse in KRAS c.35 G > A compared to wild-type and/or other mutant.
Careful decision-making process including evaluation of patient's fitness, and individual safety should be included to select FIr-B/FOx intensive first line regimen in young-elderly MCRC patients. KRAS, and specifically c.35 G > A mutant genotype, may significantly affect clinical outcome in patients unfit for FIr-B/FOx.
根据FIr-B/FOx方案，贝伐单抗联合三联化疗作为年轻老年转移性结直肠癌（MCRC）患者的一线治疗可能更有效。在身体状况不佳的患者中，个体化治疗显示出更差的临床结果。
根据年龄和合并症（累积疾病评定量表）对老年患者进行临床评估，以选择适合的患者采用FIr-B/FOx方案，不适合的老年患者采用个体化治疗。评估了限制毒性综合征（LTS）。
在17个月的随访中，28例接受一线FIr-B/FOx治疗的年轻老年患者：客观缓解率（ORR）为79%，无进展生存期（PFS）为11个月，总生存期（OS）为21个月。根据KRAS基因型，临床结果无显著差异。3-4级毒性反应为腹泻21%，粘膜炎11%，中性粒细胞减少11%。LTS为46%，多部位的明显多于单部位。在8个月的随访中，37例身体状况不佳的患者：ORR为37%，PFS为7个月，OS为13个月。与突变患者相比，KRAS野生型患者的PFS有显著差异，而OS无显著差异。与野生型和/或其他突变体相比，KRAS c.35 G > A患者的PFS和OS显著更差。
在年轻老年MCRC患者中选择FIr-B/FOx强化一线方案时，应包括仔细的决策过程，包括评估患者的身体状况和个体安全性。KRAS，特别是c.35 G > A突变基因型，可能会显著影响不适合FIr-B/FOx治疗患者的临床结果。
