Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Colorectal Cancer. 2020 Dec;19(4):248-255.e6. doi: 10.1016/j.clcc.2020.05.010. Epub 2020 Jun 5.
It has been determined that right-sided metastatic colorectal cancer (mCRC) has a worse prognosis for overall survival (OS). Currently, there is no consensus on the best systemic regimen for treatment-naive right-sided tumors. We compared the impact of subsequent therapies on OS of patients treated with FOLFOXIRI (leucovorin, 5-fluorouracil, oxaliplatin, irinotecan) versus doublet regimens.
Data of patients with treatment-naive right-sided mCRC who received FOLFOXIRI or doublet regimens between January 2001 to December 2018 were retrospectively analyzed. OS was compared between the two groups, and prognostic factors were assessed by multivariate analysis.
A total of 196 patients were selected; 33 patients received FOLFOXIRI and 163 patients doublet therapy. Median follow-up was 82.3 months. The FOLFOXIRI cohort received fewer subsequent lines of therapies (61% vs. 78%, P = .043). The greater the number of subsequent lines of therapy, the lower the risk of death (hazard ratio [95% confidence interval] 0.67 [0.46-0.99], 0.62 [0.45-0.86], and 0.56 [0.39-0.81] for > 1, > 2, and > 3 lines, respectively). By multivariate analysis, metastasectomy and bevacizumab with subsequent lines of therapy were the variables with greatest positive impact on OS (respectively, hazard ratio [95% confidence interval] 0.54 [0.38-0.78] and 0.61 [0.44-0.84]).
Patients with treatment-naive right-sided mCRC who received front-line FOLFOXIRI had a lower number of subsequent therapies than patients who received doublet regimens. Our findings highlight the relevance of the continuum of care in mCRC, regardless of the first-line regimen, and the importance of careful selection of patients for the FOLFOXIRI regimen.
已确定右侧转移性结直肠癌（mCRC）的总生存期（OS）预后较差。目前，对于初治右侧肿瘤，尚无最佳的全身治疗方案。我们比较了接受 FOLFOXIRI（亚叶酸、5-氟尿嘧啶、奥沙利铂、伊立替康）与双药方案治疗的患者的后续治疗对 OS 的影响。
回顾性分析了 2001 年 1 月至 2018 年 12 月期间接受初治右侧 mCRC 治疗的患者，比较了这两组患者的 OS，并通过多变量分析评估了预后因素。
共选择了 196 例患者，其中 33 例患者接受 FOLFOXIRI 治疗，163 例患者接受双药治疗。中位随访时间为 82.3 个月。FOLFOXIRI 组接受的后续治疗线数较少（61% vs. 78%，P=0.043）。接受后续治疗线数越多，死亡风险越低（危险比[95%置信区间]0.67[0.46-0.99]、0.62[0.45-0.86]和 0.56[0.39-0.81]，分别为>1、>2 和>3 条线）。多变量分析显示，转移灶切除术和贝伐单抗联合后续治疗是对 OS 影响最大的变量（分别为危险比[95%置信区间]0.54[0.38-0.78]和 0.61[0.44-0.84]）。
接受初治右侧 mCRC 的 FOLFOXIRI 一线治疗的患者接受后续治疗的次数少于接受双药方案治疗的患者。我们的发现强调了 mCRC 连续治疗的相关性，无论一线方案如何，以及仔细选择患者接受 FOLFOXIRI 方案的重要性。
