Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania.
Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
PLoS One. 2021 Apr 28;16(4):e0248922. doi: 10.1371/journal.pone.0248922. eCollection 2021.
Colorectal cancer remains one of the most frequent malignancies (third place at both genders) worldwide in the last decade, owing to significant changes in modern dietary habits. Approximately half of the patients develop metastases during the course of their disease. The available therapeutic armamentarium is constantly evolving, raising questions regarding the best approach for improving survival. Bevacizumab remains one of the most widely used therapies for treating metastatic colorectal cancer and can be used after progression. This study aimed to identify the best chemotherapy partner for bevacizumab after progression. We performed a retrospective analysis of patients with metastatic colorectal cancer who were treated with bevacizumab as first- and second-line chemotherapy. Data were collected for 151 patients, 40 of whom were treated with double-dose bevacizumab after the first progression. The two standard chemotherapy regimens combined with bevacizumab were FOLFIRI/CAPIRI and FOLFOX4/CAPEOX. The initiation of first-line treatment with irinotecan-based chemotherapy improved progression-free survival and time to treatment failure but not overall survival. After the first progression, retreatment with the same regimen as that used in the induction phase was the best approach for improving overall survival (median overall survival: 46.5 vs. 27.0 months for the same vs. switched strategy, respectively). No correlations were observed between the dose intensity of irinotecan, oxaliplatin, 5-fluorouracil, or bevacizumab and the overall survival, progression-free survival in the first-/second-line treatment, and time to treatment failure. Interaction between an irinotecan-based regimen as a second-line treatment and double-dose bevacizumab after progression was associated with an improved overall survival (p = 0.06). Initiating systemic treatment with an irinotecan-based regimen in combination with bevacizumab improved the progression-free survival in the first-line treatment and time to treatment failure. In terms of overall survival, bevacizumab treatment after the first progression is better partnered with the same regimen as that used in the induction phase.
在过去十年中，由于现代饮食习惯的显著变化，结直肠癌仍然是全球最常见的恶性肿瘤之一（在两性中均排名第三）。大约一半的患者在疾病过程中会发展为转移。可用的治疗手段不断发展，这引发了关于改善生存的最佳方法的问题。贝伐珠单抗仍然是治疗转移性结直肠癌最广泛使用的疗法之一，并且可以在进展后使用。本研究旨在确定贝伐珠单抗进展后的最佳化疗伙伴。我们对接受贝伐珠单抗作为一线和二线化疗的转移性结直肠癌患者进行了回顾性分析。共收集了 151 名患者的数据，其中 40 名患者在首次进展后接受了双倍剂量的贝伐珠单抗治疗。与贝伐珠单抗联合使用的两种标准化疗方案是 FOLFIRI/CAPIRI 和 FOLFOX4/CAPEOX。一线治疗中伊立替康为基础的化疗的起始改善了无进展生存期和治疗失败时间，但没有改善总生存期。在首次进展后，用诱导阶段使用的相同方案进行再治疗是改善总生存期的最佳方法（中位总生存期：分别为 46.5 个月和 27.0 个月，对于相同和转换策略）。伊立替康、奥沙利铂、5-氟尿嘧啶或贝伐珠单抗的剂量强度与总生存期、一线/二线治疗中的无进展生存期和治疗失败时间均无相关性。二线治疗中伊立替康为基础的方案与进展后双倍剂量贝伐珠单抗的相互作用与总生存期的改善相关（p = 0.06）。起始以伊立替康为基础的方案联合贝伐珠单抗的系统治疗可改善一线治疗中的无进展生存期和治疗失败时间。就总生存期而言，首次进展后贝伐珠单抗治疗与诱导阶段使用的相同方案结合更好。
