Hsieh Yao-Yu, Su Yu-Li, Kuan Feng-Che, Chen Shu-Chuan Grace, Chang Chia-Lun, Shao Yu-Yun, Tsai Ching-Wen, Liang Yi-Hsin
Division of Hematology and Oncology, Taipei Medical University Shuang Ho Hospital New Taipei 23561, Taiwan.
Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University Taipei 11031, Taiwan.
Am J Cancer Res. 2024 Dec 15;14(12):5909-5920. doi: 10.62347/MUCQ4129. eCollection 2024.
The combination of anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (mAb) and doublet chemotherapy is the standard first-line treatment for patients with wild-type metastatic colorectal cancer (mCRC). Some patients may require secondary resection after first-line treatment. However, it remains unclear whether targeted therapy should be continued after liver resection. To investigate whether targeted therapy can be spared after secondary resection, we retrospectively analyzed data from the Taiwan National Health Insurance Research Database for patients with wild-type mCRC who received first-line anti-EGFR mAb plus doublet chemotherapy. Between 2013 and 2018, 5694 mCRC patients were screened, with 174 meeting the eligibility criteria and being enrolled in this study. Among them, 153 patients continued anti-EGFR mAb after secondary resection. These patients demonstrated a significant improvement in overall survival (OS) but not in time to treatment failure. Postresection anti-EGFR mAb conferred OS benefits compared to no anti-EGFR mAb (43.17 vs. 31.41 months; = 0.0064). When stratified by assessment period, OS was longer in patients assessed between 2016 and 2018 than in those assessed between 2012 and 2015 (not reached vs. 39.87 months; = 0.1819). However, no significant difference was observed in time to treatment failure when stratified by assessment period or primary tumor location. A multivariate analysis revealed that postresection anti-EGFR mAb was an independent predictor of prolonged OS. In conclusion, for mCRC patients who have undergone secondary resection after first-line anti-EGFR mAb plus doublet chemotherapy, continuing anti-EGFR mAb may significantly extend OS, regardless of the primary tumor location.
抗表皮生长因子受体(EGFR)单克隆抗体(mAb)与双联化疗联合使用是野生型转移性结直肠癌(mCRC)患者的标准一线治疗方案。部分患者在一线治疗后可能需要进行二次切除。然而,肝切除术后是否应继续进行靶向治疗仍不明确。为了研究二次切除后是否可以省去靶向治疗,我们回顾性分析了台湾国民健康保险研究数据库中接受一线抗EGFR mAb加双联化疗的野生型mCRC患者的数据。2013年至2018年期间,共筛选出5694例mCRC患者,其中174例符合纳入标准并被纳入本研究。其中,153例患者在二次切除后继续使用抗EGFR mAb。这些患者的总生存期(OS)有显著改善,但至治疗失败时间无改善。与未使用抗EGFR mAb相比,切除术后使用抗EGFR mAb可带来OS获益(43.17个月对31.41个月;P = 0.0064)。按评估期分层时,2016年至2018年评估的患者的OS长于2012年至2015年评估的患者(未达到对39.87个月;P = 0.1819)。然而,按评估期或原发肿瘤部位分层时,至治疗失败时间未观察到显著差异。多因素分析显示,切除术后使用抗EGFR mAb是OS延长的独立预测因素。总之,对于一线抗EGFR mAb加双联化疗后接受二次切除的mCRC患者,继续使用抗EGFR mAb可能显著延长OS,无论原发肿瘤部位如何。