Artru Pascal, Bennouna Jaafar, Lievre Astrid, Ducreux Michel, Lledo Gérard
Hôpital privé Jean-Mermoz, oncologie digestive, 55, avenue Mermoz, 69008 Lyon, France.
CHU de Nantes, service d'hépatogastroentérologie, oncologie digestive, 44000 Nantes, France.
Bull Cancer. 2018 Apr;105(4):408-414. doi: 10.1016/j.bulcan.2017.12.010. Epub 2018 Feb 22.
The introduction of new regimens and targeted therapies has prolonged survival in metastatic colorectal cancer from 1 year during the fluoropyrimidines-only era to more than 30 months today. Avoiding the cumulative toxicity of oxaliplatin, but also the physical or psychological asthenia of prolonged chemotherapy, is currently a worthwhile management goal. Data from randomized controlled trials indicate that a formalized stop-and-go approach to the delivery of oxaliplatin does not compromise efficacy. This paper presents also a critical review of the randomized trials evaluating the place of bevacizumab and cetuximab as maintenance therapy. To conclude we recommend chemotherapy holidays only after 4 to 6 months of chemotherapy and only in the population of very good responders to the induction treatment.
新治疗方案和靶向治疗的引入已将转移性结直肠癌患者的生存期从仅使用氟嘧啶类药物时代的1年延长至如今的30多个月。避免奥沙利铂的累积毒性,以及长期化疗带来的身体或心理虚弱,是目前值得追求的管理目标。随机对照试验的数据表明,采用规范化的奥沙利铂间歇给药方法不会影响疗效。本文还对评估贝伐单抗和西妥昔单抗作为维持治疗地位的随机试验进行了批判性综述。最后,我们建议仅在化疗4至6个月后,且仅在诱导治疗反应非常好的患者群体中给予化疗假期。