Tao Jialong, Zhang Yingtian, Wang Yanjie, Huang Sijia, Gao Wenwen, Dai Liya, Feng Zhengyang, Jiao Chenchen, Zhang Yusong
Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Emergency Medicine, Changshu No. 2 People's Hospital, Affiliated Changshu Hospital of Nantong University, Changshu, China.
J Gastrointest Oncol. 2024 Apr 30;15(2):630-640. doi: 10.21037/jgo-24-76. Epub 2024 Apr 10.
After the failure of standard first- and second-line treatments, including oxaliplatin, irinotecan, and 5-fluorouracil (5-FU) combined with targeted drugs, the currently recommended third-line regimens for metastatic colorectal cancer (mCRC) include TAS-102, regorafenib, and fruquintinib. However, these regimens have the drawbacks of mediocre efficacy, substantive side effects, and high cost. Therefore, more effective, economical regimens with fewer side effects are needed in clinical practice. In this study, we assessed the efficacy and safety of gemcitabine plus raltitrexed or S-1 as a third- or later-line treatment in comparison to those of standard third-line therapies for patients with mCRC.
Patients with previous failures of at least two lines of standard therapy with oxaliplatin, 5-FU, irinotecan, or capecitabine combined with targeted drugs were included. The participants received standard third-line therapies (including TAS-102, regorafenib, and fruquintinib) or gemcitabine plus raltitrexed or S-1 until disease progression, death, or intolerable toxicity arose. Imaging follow-up was performed every 3 months during their treatment. Progression-free survival (PFS) and overall survival (OS) were recorded. Cox regression analysis was used to investigate the potential predictors of survival.
From April 2018 to October 2022, 60 patients with mCRC were enrolled in our study. The numbers of patients in the chemotherapy, fruquintinib, regorafenib, and TAS-102 groups were 13, 15, 17, and 15, respectively; the median OS of the four groups was 7.4, 6.1, 8.3, and 6.7 months (P=0.384), respectively; the median PFS was 4.1, 3.4, 4.4, and 2.3 months (P=0.656), respectively; the overall response rate was 7.69%, 6.67%, 0.00%, and 13.33%, respectively; and the disease control rate was 61.54%, 60.00%, 70.59%, and 60.00%, respectively. Additionally, multivariate analysis revealed that primary lesion located in the rectum was adverse independent prognostic factors for OS. A typical case is presented in this article.
The gemcitabine plus raltitrexed or S-1 regimen is a potential regimen with tolerable adverse reactions and low cost for patients with mCRC.
在包括奥沙利铂、伊立替康和5-氟尿嘧啶（5-FU）联合靶向药物在内的标准一线和二线治疗失败后，目前推荐的转移性结直肠癌（mCRC）三线治疗方案包括TAS-102、瑞戈非尼和呋喹替尼。然而，这些方案存在疗效一般、副作用大以及成本高的缺点。因此，临床实践中需要更有效、经济且副作用更少的方案。在本研究中，我们评估了吉西他滨联合雷替曲塞或S-1作为三线或更后线治疗与mCRC患者标准三线治疗相比的疗效和安全性。
纳入既往至少两线含奥沙利铂、5-FU、伊立替康或卡培他滨联合靶向药物的标准治疗失败的患者。参与者接受标准三线治疗（包括TAS-102、瑞戈非尼和呋喹替尼）或吉西他滨联合雷替曲塞或S-1，直至疾病进展、死亡或出现无法耐受的毒性。治疗期间每3个月进行一次影像学随访。记录无进展生存期（PFS）和总生存期（OS）。采用Cox回归分析来研究生存的潜在预测因素。
2018年4月至2022年10月，60例mCRC患者纳入本研究。化疗组、呋喹替尼组、瑞戈非尼组和TAS-102组的患者人数分别为13例、15例、17例和15例；四组的中位OS分别为7.4个月、6.1个月、8.3个月和6.7个月（P = 0.384）；中位PFS分别为4.1个月、3.4个月、4.4个月和2.3个月（P = 0.656）；总缓解率分别为7.69%、6.67%、0.00%和13.33%；疾病控制率分别为61.54%、60.00%、70.59%和60.00%。此外，多因素分析显示，原发灶位于直肠是OS的不良独立预后因素。本文展示了一个典型病例。
吉西他滨联合雷替曲塞或S-1方案对于mCRC患者是一种不良反应可耐受且成本低的潜在方案。
