Fernandes Gustavo Dos Santos, Braghiroli Maria Ignez, Artioli Michelle, Paterlini Ana Carolina Carvalho Rocha, Teixeira Marcela Crosara, Gumz Brenda Pires, Girardi Daniel da Motta, Braghiroli Oddone F M, Costa Frederico Perego, Hoff Paulo M
Hospital Sírio-Libanês, SGAS 613-conjunto E lote 95-Asa Sul, Brasília, DF, 70200-001, Brazil.
Hospital Sírio-Libanês, São Paulo, Brazil.
J Gastrointest Cancer. 2018 Dec;49(4):470-475. doi: 10.1007/s12029-017-0001-3.
Our objective was to evaluate the benefit of re-exposing patients with refractory metastatic colorectal cancer (mCRC) to a combination of oxaliplatin, irinotecan and 5-fluorouracil treatment.
We retrospectively analysed patients with mCRC who received a combination of oxaliplatin, irinotecan and fluorouracil as a rechallenge regimen after progressing on the same drugs. Both FOLFOXIRI and FOLFIRINOX were used. Toxicity was evaluated for each treatment cycle, and survival analysis was performed using the Kaplan-Meier method.
A total of 21 patients who were treated between January 2011 and December 2013 were selected for this study. Most of the patients (95.2%) had an ECOG status of 0-1. The median age at diagnosis was 52.1 years (range 36-77 years), and 14 (66.6%) patients had wild-type KRAS. Thirteen patients received FOLFIRINOX, and eight received FOLFOXIRI. Most patients had previously received at least three regimens, with 80% receiving anti-VEGF and 66% anti-EGFR antibodies. The response rate was 38%, and 24% patients had stable disease. The median time to disease progression was 4.0 months (range 1.0-9.1 months), and the median overall survival duration was 8.6 months (range 6.3-11.5 months). Most patients required dose adjustment and treatment delays. One patient experienced grade 5 neutropenic sepsis.
Both FOLFIRINOX and FOLFOXIRI are active and potentially feasible rechallenge treatment options for heavily pretreated patients with good performance status. With dose reduction and close monitoring for toxicity, the risk of serious adverse events can be minimised.
我们的目标是评估难治性转移性结直肠癌（mCRC）患者再次接受奥沙利铂、伊立替康和5-氟尿嘧啶联合治疗的益处。
我们回顾性分析了在使用相同药物治疗进展后接受奥沙利铂、伊立替康和氟尿嘧啶联合方案再次治疗的mCRC患者。FOLFOXIRI和FOLFIRINOX两种方案均被使用。对每个治疗周期进行毒性评估，并采用Kaplan-Meier方法进行生存分析。
本研究共纳入2011年1月至2013年12月期间接受治疗的21例患者。大多数患者（95.2%）的东部肿瘤协作组（ECOG）体能状态为0-1。诊断时的中位年龄为52.1岁（范围36-77岁），14例（66.6%）患者为KRAS野生型。13例患者接受FOLFIRINOX方案，8例接受FOLFOXIRI方案。大多数患者此前至少接受过三种方案治疗，80%接受过抗血管内皮生长因子（VEGF）治疗，66%接受过抗表皮生长因子受体（EGFR）抗体治疗。缓解率为38%，24%的患者疾病稳定。疾病进展的中位时间为4.0个月（范围1.0-9.1个月），中位总生存时间为8.6个月（范围6.3-11.5个月）。大多数患者需要调整剂量和延迟治疗。1例患者发生5级中性粒细胞减少性败血症。
FOLFIRINOX和FOLFOXIRI对于体能状态良好、经过大量治疗的患者都是有效的且可能可行的再次治疗选择。通过降低剂量并密切监测毒性，可以将严重不良事件的风险降至最低。
