Chen Chou-Pin, Ke Tao-Wei, Cheng Rebecca, Wang Jaw-Yuan
Veterans General Hospital, Taichung.
China Medical University Hospital, Taichung.
Transl Cancer Res. 2020 Sep;9(9):5645-5654. doi: 10.21037/tcr-20-608.
The development of new anti-angiogenic agents targeting the vascular endothelial growth factor (VEGF) and epidermal growth factor receptor pathways has greatly expanded the therapeutic options for patients with metastatic colorectal cancer (mCRC). Although these new agents have considerably improved survival outcomes compared with conventional chemotherapeutic regimens, the optimal integration of these drugs into the management of patients with mCRC continues to develop. One particular challenge is the identification of patient subgroups that will benefit from treatment with a specific targeted agent. In RAISE, a phase III randomized, placebo-controlled clinical trial, the VEGF receptor 2 antagonist ramucirumab in combination with fluorouracil plus leucovorin and irinotecan demonstrated efficacy as a second-line treatment for patients with mCRC. Ramucirumab is approved for the treatment of patients with mCRC in Taiwan but, due to lack of reimbursement, is often reserved for use as a third-line or later treatment. This narrative review of prespecified and analyses of the RAISE study data, and data from other ramucirumab trials and real-world studies, summarizes the efficacy and tolerability of ramucirumab in the second-line treatment of different subpopulations of patients with mCRC. The aim was to identify patients most likely to benefit from treatment with second-line ramucirumab, with a view to illustrating the potential benefit of integrating this regimen into Taiwanese or Asian treatment practice.
针对血管内皮生长因子（VEGF）和表皮生长因子受体途径的新型抗血管生成药物的研发，极大地扩展了转移性结直肠癌（mCRC）患者的治疗选择。尽管与传统化疗方案相比，这些新药显著改善了生存结局，但如何将这些药物最佳地整合到mCRC患者的治疗中仍在不断发展。一个特别的挑战是确定能从特定靶向药物治疗中获益的患者亚组。在RAISE这一III期随机、安慰剂对照临床试验中，VEGF受体2拮抗剂雷莫西尤单抗联合氟尿嘧啶加亚叶酸钙和伊立替康，对mCRC患者显示出二线治疗疗效。雷莫西尤单抗在台湾被批准用于治疗mCRC患者，但由于缺乏报销，通常留作三线或更晚阶段的治疗。本文对RAISE研究数据的预设分析以及其他雷莫西尤单抗试验和真实世界研究的数据进行叙述性综述，总结了雷莫西尤单抗在二线治疗不同亚组mCRC患者中的疗效和耐受性。目的是确定最有可能从二线雷莫西尤单抗治疗中获益的患者，以阐明将该方案整合到台湾或亚洲治疗实践中的潜在益处。
