贝伐珠单抗在新辅助化疗及同期放化疗治疗难治性宫颈癌患者中的疗效和安全性。
Efficacy and safety of bevacizumab in neoadjuvant and concurrent chemoradiotherapy for refractory cervical cancer patients.
机构信息
Department of Radiation Oncology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China; Department of Radiation Oncology, the First Affiliated Hospital of Air Force Medical University, Xi'an, China.
Department of Radiation Oncology, the First Affiliated Hospital of Air Force Medical University, Xi'an, China.
出版信息
Biomol Biomed. 2024 Oct 17;24(6):1586-1594. doi: 10.17305/bb.2024.10528.
A platinum-based concurrent chemoradiotherapy (CCRT) is the standard treatment for refractory cervical cancer (CC). However, the recurrence of disease and the occurrence of metastasis remain prevalent. We observed the long-term efficacy and safety of bevacizumab combined with neoadjuvant chemotherapy (NACT) and CCRT in refractory CC. A total of 62 patients with refractory CC were enrolled in this study from January 2016 to December 2019. The NACT regimen included bevacizumab (7.5 mg/kg), docetaxel (75 mg/m2), and cisplatin (75 mg/m2), administered tri-weekly for 2 cycles. The CCRT regimen included bevacizumab (7.5 mg/kg) and cisplatin (75 mg/m2), administered tri-weekly for 2 cycles. A dose of 45-50 Gy was prescribed for external beam radiotherapy (EBRT), while 30-35 Gy in 4-5 fractions was prescribed for brachytherapy (BT). Among the patients, 21 patients (33.9%) were at stages IIB-IIIB, 8 patients (12.9%) were at stage IIIC1, 19 patients (30.6%) were at stage IIIC2, and 14 patients (22.6%) were at stage IVB. Pelvic, para-aortic, supraclavicular, and inguinal lymph node metastases were discovered in 41 patients (66.1%). The median follow-up was 49.8 months (12.3-82.7 months). The median tumor volumes pre-treatment, after NACT, and before BT were 84.64 ± 53.15 cm3, 1.64 ± 13.15 cm3, and 0 ± 1.5 cm3, respectively. Complete clinical response (cCR) rates after NACT and EBRT were 35.5% and 66.1%, respectively. Four years after the diagnosis, the overall survival (OS) rate was 78.6%, the local region-free survival (LRFS) rate was 91.3%, the disease-free survival (DFS) rate was 70.6%, and the distant metastasis-free survival (DMFS) rate was 81.4%. A total of 29 patients (46.8%) experienced grade 3/4 hematological toxicity, 3 patients (4.8%) experienced grade 3 gastrointestinal toxicities, and none experienced grade 5 adverse events. Bevacizumab combined with NACT and CCRT significantly improved cCR and OS in refractory CC with acceptable toxicity.
贝伐珠单抗联合新辅助化疗和放化疗治疗复发性宫颈癌的疗效及安全性分析
背景
铂类同步放化疗（CCRT）是治疗复发性宫颈癌（CC）的标准治疗方法。然而，疾病的复发和转移仍然普遍存在。我们观察了贝伐珠单抗联合新辅助化疗（NACT）和 CCRT 治疗复发性 CC 的长期疗效和安全性。
方法
本研究纳入了 2016 年 1 月至 2019 年 12 月期间的 62 例复发性 CC 患者。NACT 方案包括贝伐珠单抗（7.5mg/kg）、多西他赛（75mg/m2）和顺铂（75mg/m2），每 3 周给药 2 个周期。CCRT 方案包括贝伐珠单抗（7.5mg/kg）和顺铂（75mg/m2），每 3 周给药 2 个周期。外照射放疗（EBRT）给予 45-50Gy，腔内放疗（BT）给予 30-35Gy，共 4-5 次。患者中，21 例（33.9%）为 IIB-IIIB 期，8 例（12.9%）为 IIIC1 期，19 例（30.6%）为 IIIC2 期，14 例（22.6%）为 IVB 期。41 例（66.1%）患者发现盆腔、腹主动脉旁、锁骨上和腹股沟淋巴结转移。中位随访时间为 49.8 个月（12.3-82.7 个月）。治疗前、NACT 后和 BT 前肿瘤体积中位数分别为 84.64±53.15cm3、1.64±13.15cm3 和 0±1.5cm3。NACT 和 EBRT 后的完全临床缓解（cCR）率分别为 35.5%和 66.1%。诊断后 4 年，总生存率（OS）为 78.6%，局部区域无复发生存率（LRFS）为 91.3%，无病生存率（DFS）为 70.6%，无远处转移生存率（DMFS）为 81.4%。29 例（46.8%）患者发生 3/4 级血液学毒性，3 例（4.8%）患者发生 3 级胃肠道毒性，无 5 级不良事件。
结论
贝伐珠单抗联合 NACT 和 CCRT 可显著提高复发性 CC 的 cCR 和 OS，且毒性可接受。
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