Matsuhashi Nobuhisa, Takahashi Takao, Matsui Satoshi, Tanahashi Toshiyuki, Imai Hisashi, Tanaka Yoshihiro, Yamaguchi Kazuya, Yoshida Kazuhiro
Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501-1194, Japan.
Int J Oncol. 2018 May;52(5):1391-1400. doi: 10.3892/ijo.2018.4322. Epub 2018 Mar 16.
Achieving tumor shrinkage may be a clinically relevant improvement in the treatment of metastatic colorectal cancer (mCRC). The present study attempted to evaluate early tumor shrinkage (ETS) and deepness of response over 6-8 courses of therapy, which were assessed previously in first-line trials of anti-epidermal growth factor receptor (EGFR) monoclonal antibodies. A total of 37 patients with mCRC that was considered unresectable or borderline resectable were enrolled in the study. Patients exhibited the wild-type RAS gene, and anti-EGFR monoclonal antibodies were used as the first-line treatment in the Department of Surgical Oncology at Gifu University School of Medicine (Gifu, Japan) between January 2010 and March 2017. Tumor shrinkage and other characteristics were evaluated according to the Response Evaluation Criteria In Solid Tumors (RECIST) classifications (version 1.1). The 3-year overall survival (OS) rate was >60.0% for all cases (n=37). The mean tumor shrinkage rate in the right side of the colon according to the RECIST classifications was -11.1%, whereas that for CRC on the left side showed a statistically significant difference at -54.0% (P=0.042). In addition, the rates of OS for stable disease + progressive disease compared with partial response + complete response, and those of OS for conversion therapy compared with non-conversion therapy were significantly different (both P<0.001). Carcinoembryonic antigen (CEA) was suggested to be a possible predictive factor for convalescence due to the 50% drop in its value after the 6-8 courses of therapy. Overall, the predictive performance of ETS with respect to PFS and OS is at least as good as the standard RECIST response, with the advantage of an earlier assessment, and this may improve convalescence, with CEA as a marker in support of ETS over a clinical treatment course. In RAS wild-type patients, it is important to evaluate the rate of tumor shrinkage from the beginning of the first-line treatment until 6-8 courses of anti-EGFR monoclonal antibodies have been administered.
实现肿瘤缩小可能是转移性结直肠癌（mCRC）治疗中一项具有临床意义的改善。本研究试图评估在6 - 8个疗程的治疗中早期肿瘤缩小（ETS）情况及反应深度，这些在先前抗表皮生长因子受体（EGFR）单克隆抗体的一线试验中已有评估。共有37例被认为不可切除或边界可切除的mCRC患者纳入本研究。患者表现为野生型RAS基因，2010年1月至2017年3月期间，在日本岐阜大学医学院外科肿瘤学系，抗EGFR单克隆抗体被用作一线治疗。根据实体瘤疗效评价标准（RECIST）分类（第1.1版）评估肿瘤缩小情况及其他特征。所有病例（n = 37）的3年总生存率（OS）>60.0%。根据RECIST分类，结肠右侧的平均肿瘤缩小率为-11.1%，而左侧结直肠癌的平均肿瘤缩小率为-54.0%，差异有统计学意义（P = 0.042）。此外，疾病稳定 + 疾病进展的OS率与部分缓解 + 完全缓解相比，以及转化治疗的OS率与非转化治疗相比，差异均有统计学意义（均P < 0.001）。癌胚抗原（CEA）被认为可能是康复的预测因素，因为在6 - 8个疗程治疗后其值下降了50%。总体而言，ETS对无进展生存期（PFS）和OS的预测性能至少与标准RECIST反应一样好，且具有更早评估的优势，这可能改善康复情况，CEA可作为支持ETS在临床治疗过程中的一个标志物。在RAS野生型患者中，从一线治疗开始直至给予6 - 8个疗程抗EGFR单克隆抗体期间评估肿瘤缩小率很重要。
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