转移性结直肠癌进展后的治疗：贝伐单抗剂量加倍还是不加倍？

Treatment beyond progression in metastatic colorectal cancer: to double or not to double the dose of bevacizumab?

作者信息

Bochiș Ovidiu-Vasile, Vlad Cătălin, Căinap Călin, Achimaș Cadariu Patriciu, Sur Daniel, Havasi Andrei, Vidrean Andreea, Mureșan Alexandra, Piciu Andra, Bota Madalina, Constantin Anne Marie, Tat Tiberiu, Maniu Dana, Crișan Ovidiu, Vasile Cioban Cosmin, Bălăcescu Ovidiu, Coza Ovidiu, Bălăcescu Loredana, Marta Monica Mihaela, Căinap Simona

机构信息

Institute of Oncology, "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania.

出版信息

J BUON. 2020 Mar-Apr;25(2):875-883.

PMID:32521881

Abstract

PURPOSE

Bevacizumab or cetuximab represent the standard treatment in association with classical chemotherapy in confirmed metastatic colorectal cancer (mCRC). Bevacizumab could be continued after the first disease progression with an overall survival (OS) advantage, compared to chemotherapy alone, but the optimal dose remains a debatable issue.

METHODS

In a retrospective analysis of mCRC patients treated with bevacizumab, we selected patients with administration beyond progression, and stratified them according to the dose received- same dose bevacizumab (SDB) as first-line chemotherapy or double dose bevacizumab (DDB). For each group we evaluated OS, time to treatment failure (TTF) and progression-free survival in the first-line (PFS1) and in the second-line (PFS2).

RESULTS

In the first-line therapy, oxaliplatin backbone regimen was used in 73% SDB, compared with 22.5% DDB patients, while irinotecan was used in 75% DDB and 27% SDB patients. Second-line oxaliplatin was given to 50% DDB and 29.7% SDB patients, while irinotecan was administered to 47.5% DDB and 70.3% SDB patients. The median values were: OS - 41 months in the DDB group and 25 months in the SDB group (p = 0.01); TTF - 24 months in the DDB group and 19 months in the SDB group (p=0.009); PFS1 - 17 months in the DDB group and 12 months in the SDB group (p=0.008); PFS2 - 9 months in the DDB group and 5 months in the SDB group (p = 0.03).

CONCLUSIONS

Doubling the dose of bevacizumab at progression seems to provide OS and PFS advantage for mCRC patients.

摘要

目的

贝伐单抗或西妥昔单抗是确诊的转移性结直肠癌（mCRC）经典化疗联合治疗的标准方案。与单纯化疗相比，首次疾病进展后继续使用贝伐单抗可带来总生存期（OS）优势，但最佳剂量仍是一个有争议的问题。

方法

在一项对接受贝伐单抗治疗的mCRC患者的回顾性分析中，我们选择了疾病进展后仍接受治疗的患者，并根据接受的剂量进行分层——一线化疗时使用相同剂量的贝伐单抗（SDB）或双倍剂量的贝伐单抗（DDB）。我们评估了每组患者的总生存期、治疗失败时间（TTF）以及一线（PFS1）和二线（PFS2）的无进展生存期。

结果

在一线治疗中，73%的SDB组患者使用了以奥沙利铂为主的方案，而DDB组患者为22.5%；75%的DDB组患者和27%的SDB组患者使用了伊立替康。二线治疗时，50%的DDB组患者和29.7%的SDB组患者接受了奥沙利铂治疗，47.5%的DDB组患者和70.3%的SDB组患者接受了伊立替康治疗。中位数如下：DDB组总生存期为41个月，SDB组为25个月（p = 0.01）；DDB组治疗失败时间为24个月，SDB组为19个月（p = 0.009）；DDB组一线无进展生存期为17个月，SDB组为12个月（p = 0.008）；DDB组二线无进展生存期为9个月，SDB组为5个月（p = 0.03）。