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基于中国患者援助项目背景的晚期结直肠癌靶向维持治疗回顾性探索

A Retrospective Exploration of Targeted Maintenance Therapy in Advanced Colorectal Cancer: Based on the Background of Chinese Patient Assistance Program.

作者信息

Hu Hanguang, Liu Xue, Cai Wen, Wu Dehao, Xu Junxi, Yuan Ying

机构信息

Departments of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Front Oncol. 2020 Apr 23;10:522. doi: 10.3389/fonc.2020.00522. eCollection 2020.

Abstract

Maintenance therapy with bevacizumab (Bev) in patients with colorectal cancer (CRC) provides progression-free survival (PFS) benefits. However, the role of maintenance therapy with an anti-EGFR monoclonal antibody has not been established. Eligible CRC patients were assigned to maintenance therapy with cetuximab (Cet; Cet group) or Bev (Bev group). PFS, the duration of maintenance therapy, and safety were analyzed. Cox multivariate regression analyses were performed to determine independent prognostic factors. A total of 143 eligible patients were assigned to the Cet ( = 79) or Bev ( = 64) groups. In the Cet group, all patients had KRAS wild-type. The baseline characteristics were well-balanced between the two groups, except for a higher percentage of patients with a left-sided primary tumor in the Cet group than in the Bev group (86.1 vs. 62.5%, < 0.0001). The median PFS was not significantly different between the Cet group and the Bev group: 5.9 months (95% CI 2.30-9.50) vs. 7.0 months (95% CI 3.69-10.31) (HR 1.17, 95% CI 0.77-1.79, = 0.45). The median duration of maintenance therapy in the Cet group was shorter than that in the Bev group: 4.0 months (95% CI 1.94-5.99) vs. 4.8 months (95% CI 2.68-6.98) (HR 0.90, 95% CI 0.61-1.33; = 0.59). The subgroup analyses showed that the median PFS for the first maintenance therapy and the second maintenance therapy were 3.2 months (95% CI 1.69-4.78) and 5.2 months (95% CI 1.58-8.83), respectively (HR 0.89, 95% CI 0.44-1.81; = 0.75). This study suggests that maintenance therapy with Cet or Bev can be considered an appropriate option following induction chemotherapy for selected patients with advanced CRC. Multiple maintenance therapy seems to confer survival benefits in advanced CRC. Maintenance therapy with Cet after first-line induction chemotherapy seems to be associated with greater survival benefits.

摘要

贝伐单抗(Bev)用于结直肠癌(CRC)患者的维持治疗可带来无进展生存期(PFS)获益。然而,抗表皮生长因子受体(EGFR)单克隆抗体维持治疗的作用尚未确立。符合条件的CRC患者被分配接受西妥昔单抗(Cet;西妥昔单抗组)或贝伐单抗(贝伐单抗组)的维持治疗。分析了PFS、维持治疗持续时间和安全性。进行Cox多因素回归分析以确定独立的预后因素。共有143例符合条件的患者被分配至西妥昔单抗组(n = 79)或贝伐单抗组(n = 64)。在西妥昔单抗组中,所有患者的KRAS均为野生型。两组间基线特征均衡,但西妥昔单抗组左侧原发性肿瘤患者的比例高于贝伐单抗组(86.1%对62.5%,P < 0.0001)。西妥昔单抗组和贝伐单抗组的中位PFS无显著差异:5.9个月(95%CI 2.30 - 9.50)对7.0个月(95%CI 3.69 - 10.31)(风险比[HR]1.17,95%CI 0.77 - 1.79,P = 0.45)。西妥昔单抗组维持治疗的中位持续时间短于贝伐单抗组:4.0个月(95%CI 1.94 - 5.99)对4.8个月(95%CI 2.68 - 6.98)(HR 0.90,95%CI 0.61 - 1.33;P = 0.59)。亚组分析显示,首次维持治疗和第二次维持治疗的中位PFS分别为3.2个月(95%CI 1.69 - 4.78)和5.2个月(95%CI 1.58 - 8.83)(HR 0.89,95%CI 0.44 - 1.81;P = 0.75)。本研究表明,对于部分晚期CRC患者,诱导化疗后可考虑将西妥昔单抗或贝伐单抗维持治疗作为合适的选择。多次维持治疗似乎能使晚期CRC患者获益。一线诱导化疗后使用西妥昔单抗维持治疗似乎与更大的生存获益相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874e/7190810/fb8443353194/fonc-10-00522-g0001.jpg

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