Quan Ming, Chen Zhiqin, Chen Jingde, Hai Yanan, Gao Yong
Department of Oncology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
J Gastrointest Oncol. 2022 Oct;13(5):2660-2666. doi: 10.21037/jgo-22-824.
Bevacizumab combined with fluorouracil is the currently recommended maintenance treatment for metastatic colorectal cancer, but the use of bevacizumab needs to be carried out in hospitals, which invisibly increases the risk of patients' exposure to coronavirus disease 2019 (COVID-19) during the COVID-19 epidemic. Therefore, except of the advantage of convenience, all oral drugs as the maintenance treatment can reduce hospitalization and potential exposure risk during the COVID-19 epidemic, which is worth further exploration.
First case was a 49-year-old male with stage IV colon adenocarcinoma and abnormal liver function who was given bevacizumab with FOLFOXIRI (8-cycles), following which his liver function recovered. Oxaliplatin was stopped upon thrombocytopenia development. The patient was finally maintained on oral fruquintinib and capecitabine therapy since November 2020, and has been progression-free for >15 months. Grade 2 leukopenia, neutropenia, and thrombocytopenia; grade 1 terminal nerve injury; and grade 1 hand and foot numbness were observed. The second case was a 48-year-old male with advanced colon cancer who underwent laparoscopic sigmoidectomy. Post-surgery, the patient was commenced on fluorouracil and leucovorin (1-cycle), followed by conversion therapy with cetuximab and chemotherapy (6-cycles). The patient underwent left hemi-hepatectomy, partial hepatectomy of the right lobe, and intraoperative radiofrequency ablation, following which he continued to receive cetuximab and chemotherapy. The patient was maintained on oral fruquintinib and capecitabine since December, 2020 and has been progression-free for >14 months. Grade1 myelosuppression, leukopenia, and neutropenia, grade 2 thrombocytopenia were observed.
This case report based on preliminary evidence advocates oral fruquintinib-capecitabine maintenance treatment as an alternative to bevacizumab-capecitabine standard therapy for CRC patients, especially in the era of COVID-19 epidemic. This scheme can reduce hospitalization and potential COVID-19 contact, and is more convenient than intravenous administration. Which should be further explored in future studies.
贝伐单抗联合氟尿嘧啶是目前推荐的转移性结直肠癌维持治疗方案，但贝伐单抗的使用需要在医院进行，这在2019冠状病毒病（COVID-19）疫情期间无形中增加了患者感染COVID-19的风险。因此，作为维持治疗的所有口服药物，除了方便这一优点外，还可在COVID-19疫情期间减少住院率和潜在暴露风险，值得进一步探索。
首例患者为一名49岁男性，患有IV期结肠腺癌且肝功能异常，接受了贝伐单抗联合FOLFOXIRI方案治疗（8个周期），之后其肝功能恢复。因出现血小板减少症停用了奥沙利铂。自2020年11月起，该患者最终接受呋喹替尼和卡培他滨口服治疗，目前已无进展超过15个月。观察到2级白细胞减少、中性粒细胞减少和血小板减少；1级末梢神经损伤；以及1级手足麻木。第二例患者为一名48岁男性，患有晚期结肠癌，接受了腹腔镜乙状结肠切除术。术后，患者开始接受氟尿嘧啶和亚叶酸钙治疗（1个周期），随后接受西妥昔单抗和化疗的转换治疗（6个周期）。该患者接受了左半肝切除术、右叶部分肝切除术和术中射频消融术，之后继续接受西妥昔单抗和化疗。自2020年12月起，该患者接受呋喹替尼和卡培他滨口服治疗，目前已无进展超过14个月。观察到1级骨髓抑制、白细胞减少和中性粒细胞减少，2级血小板减少。
本病例报告基于初步证据，提倡将呋喹替尼-卡培他滨口服维持治疗作为结直肠癌患者贝伐单抗-卡培他滨标准治疗的替代方案，尤其是在COVID-19疫情时代。该方案可减少住院率和潜在的COVID-19接触，且比静脉给药更方便。未来研究应进一步探索。
