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投稿时间：2021-05-24 网络发布日期：2021-12-20
投稿时间：2021-05-24 网络发布日期：2021-12-20
中文摘要: 目的 探讨贝伐珠单抗联合XELOX或TOMOX方案治疗初始不可切除同时性单纯肝转移的晚期结直肠癌的疗效与安全性。方法 回顾性分析2014年8月至2018年8月盐城市第一人民医院80例初始不可切除的同时性肝转移晚期结直肠癌患者的临床资料，50例予贝伐珠单抗联合XELOX方案（奥沙利铂/卡培他滨，3周为1周期）为XELOX-BEV组；30例予贝伐珠单抗联合TOMOX方案（奥沙利铂/雷替曲塞，3周为1周期）为TOMOX-BEV组。每6周评价疗效，多学科团队制定个体化治疗方案，最多完成8周期联合化疗，未达手术标准者予以贝伐珠单抗联合卡培他滨或雷替曲塞维持治疗，至疾病进展或毒副反应不可耐受。结果 XELOX-BEV组与TOMOX-BEV组，中位无疾病进展生存时间为9.1和8.9个月，中位总生存时间为36和32个月，客观有效率为62.0%和56.7%，疾病控制率为86.0%和80.3%，中位反应时间为3.3和3.5个月，一期R0切除率为8.0%和33%，二期R0/R1切除率为14.0%和13.3%，术后中位无复发生存时间为6.9和6.6个月，组间差异均无统计学意义(P>0.05)。两组主要毒副反应为中性粒细胞减少、周围神经毒性及高血压。XELOX-BEV组的手足综合征（24.0% vs 0，P=0.009）、腹泻（46.0% vs 23.3%, P=0.043）及黏膜炎（38.0% vs 16.7%，P=0.044）发生率更高，而TOMOX-BEV组的肝功能异常（40.0% vs 14.0%，P=0.008）发生率更高。结论 贝伐珠单抗联合TOMOX方案治疗初始不可切除同时性单纯肝转移晚期结直肠癌的疗效不劣于贝伐珠单抗联合XELOX方案，安全性可控，可作为晚期结肠癌肝转移治疗的选择。
Abstract:Objective To investigate the efficacy and safety of bevacizumab combined with XELOX (oxaliplatin plus capecitabine) or TOMOX (oxaliplatin plus raltitrexed) regimen in the treatment of patients with advanced colorectal cancer with initial unresectable simultaneous liver metastasis. Methods A retrospective analysis was performed on 80 patients with advanced colorectal cancer with initial unresectable simultaneous liver metastasis treated at Yancheng First People's Hospital from August 2014 to August 2018. A total of fifty patients received bevacizumab combined with XELOX regimen as XELOX-BEV group, and thirty patients received bevacizumab combined with TOMOX regimen as TOMOX-BEV group. Each chemotherapy cycle was 3 weeks in both groups. The curative effect was evaluated in every 6 weeks. Each patient received individualized treatment plan developed by the multidisciplinary team and completed 8 cycles of combined chemotherapy at most. The patients who failed to meet the criteria for surgery were treated with bevacizumab combined with capecitabine or raltitrexed until disease progression or intolerable toxic side-effects occurred. Results There was no significant difference in median progression-free survival (9.1 months vs 8.9 months）, median over all survival（36 months vs 32 months), objective response rate （62.0% vs 56.7%),disease control rate （86.0% vs 80.3%), median time to response（3.3 months vs 3.5 months), primary R0 resection rate （8.0% vs 3.3%), the secondary R0/R1 resection rate (14.0% vs 13.3%) and the postoperative median relapse-free survival （6.9 months vs 6.6 months) between XELOX-BEV group and TOMOX-BEV group(P>0.05). The main adverse events were neutropenia, peripheral neurotoxicity and hypertension in two groups. XELOX-BEV group had higher incidences of hand foot syndrome (24.0% vs 0, P=0.009), diarrhea (46.0% vs 23.3%, P=0.043) and mucositis (38.0% vs 16.7%,P=0.044). However, TOMOX-BEV group had the higher incidence of abnormal liver function (40.0% vs 14.0%, P=0.008). Conclusion In the treatment for patients with advanced colorectal cancer with initial unresectable simultaneous liver metastasis, the efficacy of TOMOX-BEV regimen is not inferior to that of XELOX-BEV, with controllable adverse events, which can be as one of the options for advanced colorectal cancer with liver metastasis.
keywords: Colorectal cancer, advanced Simultaneous liver metastasis Translational therapy Bevacizumab Chemotherapy
文章编号： 中图分类号：R735.3 文献标志码：A
基金项目:江苏省第五期“333工程”科研项目（BRA2018248）
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引用文本：
李剑萍,黄志军,许永华,等.贝伐珠单抗联合XELOX或TOMOX方案治疗初始不可切除同时性单纯肝转移的晚期结直肠癌[J].中国临床研究,2021,34(12):1614-1619.
李剑萍,黄志军,许永华,等.贝伐珠单抗联合XELOX或TOMOX方案治疗初始不可切除同时性单纯肝转移的晚期结直肠癌[J].中国临床研究,2021,34(12):1614-1619.