Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
J Cancer Res Clin Oncol. 2023 Mar;149(3):1123-1129. doi: 10.1007/s00432-022-03979-2. Epub 2022 Mar 22.
Fluorouracil, leucovorin, and irinotecan (FOLFIRI) plus bevacizumab is the standard second-line chemotherapy for patients with metastatic colorectal cancer (mCRC) who are refractory or intolerant to fluoropyrimidines and oxaliplatin. However, the benefits of incorporating fluoropyrimidines into second-line chemotherapy for patients with mCRC who are refractory to fluoropyrimidines are unknown.
We retrospectively evaluated patients with mCRC who were administered irinotecan plus bevacizumab or FOLFIRI plus bevacizumab as second-line chemotherapy at a single institution from January 2010 to April 2020. We compared the efficacy and safety of irinotecan plus bevacizumab (IRI group) with those of FOLFIRI plus bevacizumab (FOLFIRI group).
Of the 255 enrolled patients, 107 (IRI/FOLFIRI group, 31/76 patients) were eligible for analysis. After a median follow-up of 13.1 months (range 1.2-48.4) and 14.3 months (range 0.9-46.5) for the IRI and FOLFIRI groups, respectively, the median progression-free survival was 6.4 months and 5.8 months [adjusted hazard ratio (aHR), 0.82; 95% confidence interval (CI) 0.50-1.34, p = 0.44] and the median overall survival was 16.6 months and 16.5 months (aHR, 1.01; 95% CI 0.59-1.69; p = 0.97) in the IRI and FOLFIRI groups, respectively. All-grade nausea, stomatitis, neutropenia, thrombocytopenia, Grade 3/4 neutropenia, and febrile neutropenia occurred more frequently in the FOLFIRI group than in the IRI group.
Our study suggests omitting fluorouracil from FOLFIRI plus bevacizumab as the second-line chemotherapy decreases adverse events without affecting the treatment efficacy in patients with mCRC who are refractory to fluoropyrimidines. Further randomized prospective studies are warranted to validate our result.
氟尿嘧啶、亚叶酸钙和伊立替康（FOLFIRI）联合贝伐珠单抗是转移性结直肠癌（mCRC）患者的标准二线化疗方案，这些患者对氟嘧啶和奥沙利铂耐药或不耐受。然而，对于氟嘧啶耐药的 mCRC 患者，将氟嘧啶纳入二线化疗的获益尚不清楚。
我们回顾性评估了 2010 年 1 月至 2020 年 4 月在一家医疗机构接受伊立替康联合贝伐珠单抗或 FOLFIRI 联合贝伐珠单抗二线化疗的 mCRC 患者。我们比较了伊立替康联合贝伐珠单抗（IRI 组）和 FOLFIRI 联合贝伐珠单抗（FOLFIRI 组）的疗效和安全性。
在 255 名入组患者中，有 107 名（IRI/FOLFIRI 组，31/76 名患者）符合分析条件。IRI 组和 FOLFIRI 组患者的中位随访时间分别为 13.1 个月（范围 1.2-48.4）和 14.3 个月（范围 0.9-46.5）。IRI 组和 FOLFIRI 组的中位无进展生存期分别为 6.4 个月和 5.8 个月[调整后的风险比（aHR）为 0.82；95%置信区间（CI）为 0.50-1.34，p=0.44]，中位总生存期分别为 16.6 个月和 16.5 个月（aHR 为 1.01；95%CI 为 0.59-1.69；p=0.97）。FOLFIRI 组的所有级别恶心、口腔炎、中性粒细胞减少、血小板减少、3/4 级中性粒细胞减少和发热性中性粒细胞减少的发生率均高于 IRI 组。
我们的研究表明，在氟嘧啶耐药的 mCRC 患者中，省略 FOLFIRI 联合贝伐珠单抗中的氟尿嘧啶作为二线化疗可减少不良反应，而不影响治疗效果。需要进一步的随机前瞻性研究来验证我们的结果。
