西妥昔单抗和贝伐珠单抗治疗晚期结直肠癌的有效性和安全性比较
|
摘要
目的:比较西妥昔单抗和贝伐珠单抗治疗晚期结直肠癌的有效性和安全性。方法:选取2014年1月～2017年8月我院收治的晚期结直肠癌患者100例,根据患者入院先后顺序随机分为两组,所有患者均给予FOLFIRI方案进行化疗,A组在化疗的基础上给予贝伐珠单抗进行治疗,B组在化疗的基础上给予西妥昔单抗进行治疗。比较两组患者临床治疗的缓解率、控制率及不良反应的发生情况,对所有患者随访1年,记录并比较两组患者的无进展生存期。结果:两组患者的缓解率、控制率、恶心呕吐、头晕、延迟性腹泻、肝肾损伤、白细胞减少、血小板减少和尿蛋白的发生率相比均无统计学差异(P>0.05),但B组患者骨髓抑制和皮疹的发生率显著高于A组(P<0.05);两组患者的无进展生存期相比无统计学差异(P>0.05)。结论:西妥昔单抗和贝伐珠单抗治疗晚期结直肠癌的临床效果相当,且不良反应较轻,以Ⅰ～Ⅱ度为主,患者均可耐受,对症治疗后均有所缓解。西妥昔单抗易引发骨髓抑制和皮疹,在临床应用过程中需注意并进行有效预防和积极处理。
Objective: To compare the efficacy and safety of cetuximab and bevacizumab in the treatment of advanced colorectal cancer. Methods: 100 patients with advanced colorectal cancer admitted to our hospital from January 2014 to August 2017 were selected and divided into two groups according to the sequence of admission. All the patients were treated with FOLFIRI for chemotherapy, group A was treated with bevacizumab on the basis of chemotherapy, and group B was treated with cetuximab on the basis of chemotherapy.The remission rate, control rate and incidence of adverse reactions were compared between the two groups. All patients were followed up for 1 year, and no progression-free survival was recorded and compared between the two groups. Results: There was no statistical difference in the remission rate and control rate between the two groups(P>0.05). In terms of adverse reactions, there were no statistically significant difference between the two groups in the incidence of nausea and vomiting, dizziness, delayed diarrhea, liver and kidney injury, leukopenia, thrombocytopenia and urinary protein(P>0.05), but the incidence of bone marrow suppression and rash in group B was significantly higher than that in group A(P<0.05). There was no statistically significant difference in the progression-free survival between the two groups(P >0.05). Conclusion: Cetuximab and bevacizumab had equal clinical effects in the treatment of advanced colorectal cancer. But cetuximab could easy cause bone marrow suppression and rash, which should be paid attention to in the process of clinical application and effective prevention and active treatment.
Objective: To compare the efficacy and safety of cetuximab and bevacizumab in the treatment of advanced colorectal cancer. Methods: 100 patients with advanced colorectal cancer admitted to our hospital from January 2014 to August 2017 were selected and divided into two groups according to the sequence of admission. All the patients were treated with FOLFIRI for chemotherapy, group A was treated with bevacizumab on the basis of chemotherapy, and group B was treated with cetuximab on the basis of chemotherapy.The remission rate, control rate and incidence of adverse reactions were compared between the two groups. All patients were followed up for 1 year, and no progression-free survival was recorded and compared between the two groups. Results: There was no statistical difference in the remission rate and control rate between the two groups(P>0.05). In terms of adverse reactions, there were no statistically significant difference between the two groups in the incidence of nausea and vomiting, dizziness, delayed diarrhea, liver and kidney injury, leukopenia, thrombocytopenia and urinary protein(P>0.05), but the incidence of bone marrow suppression and rash in group B was significantly higher than that in group A(P<0.05). There was no statistically significant difference in the progression-free survival between the two groups(P >0.05). Conclusion: Cetuximab and bevacizumab had equal clinical effects in the treatment of advanced colorectal cancer. But cetuximab could easy cause bone marrow suppression and rash, which should be paid attention to in the process of clinical application and effective prevention and active treatment.
引文
[1]Arnold M,Sierra M S,Laversanne M,et al.Global patterns and trends in colorectal cancer incidence and mortality[J].Gut,2017,66(4):683-691
[2]Tan D,Fu Y,Su Q,et al.Prognostic role of platelet-lymphocyte ratio in colorectal cancer:A systematic review and meta-analysis[J].Medicine,2016,95(24):e3837
[3]Mlecnik B,Bindea G,Angell H K,et al.Integrative Analyses of Colorectal Cancer Show Immunoscore Is a Stronger Predictor of Patient Survival Than Microsatellite Instability[J].Immunity,2016,44(3):698-711
[4]Samawi H H,Shaheen A A,Tang P A,et al.Risk and predictors of suicide in colorectal cancer patients:a Surveillance,Epidemiology,and End Results analysis[J].Current Oncology,2017,24(6):e513-e517
[5]Dienstmann R,Vermeulen L,Guinney J,et al.Consensus molecular subtypes and the evolution of precision medicine in colorectal cancer[J].Nature Reviews Cancer,2017,17(2):79-92
[6]Huang Y Q,Liang C H,He L,et al.Development and validation of a radiomics nomogram for preoperative prediction of lymph node metastasis in colorectal cancer[J].Science Foundation in China,2016,34(4):2157-2164
[7]Lech G,S覥otwiński R,S覥odkowski M,et al.Colorectal cancer tumour markers and biomarkers:Recent therapeutic advances[J].World Journal of Gastroenterology,2016,22(5):1745-1755
[8]A Passardi,O Nanni,D Tassinari,et al.Effectiveness of bevacizumab added to standard chemotherapy in metastatic colorectal cancer:final results for first-line treatment from the ITACa randomized clinical trial[J].Annals of Oncology,2016,26(6):1201-1207
[9]Murcia O,Juárez M,Hernández-Illán E,et al.Serrated colorectal cancer:Molecular classification,prognosis,and response to chemotherapy[J].World Journal of Gastroenterology,2016,22(13):3516-3530
[10]Mcquade R M,Stojanovska V,Bornstein J C,et al.Colorectal Cancer Chemotherapy:The Evolution of Treatment and New Approaches[J].Current Medicinal Chemistry,2017,24(15):1537-1557
[11]Dong Z,Cui M Y,Peng Z,et al.Nanoparticles for Colorectal Cancer Targeted Drug Delivery and MR Imaging:Current Situation and Perspectives[J].Current Cancer Drug Targets,2016,16(6):536-550
[12]Banerjee A,Pathak S,Devi S V,et al.Strategies for targeted drug delivery in treatment of colon cancer:current trends and future perspectives[J].Drug Discovery Today,2017,22(8):1224-1232
[13]Wang J,Luo L,Wang D,et al.Combination Adjuvant Chemotherapy with Targeted Drugs for Treatment of Colorectal Cancer:A Network Meta-Analysis[J].Journal of Cellular Biochemistry,2018,119(2):1521-1537
[14]Tomida C,Yamagishi N,Nagano H,et al.VEGF pathway-targeting drugs induce evasive adaptation by activation of neuropilin-1/cMet in colon cancer cells[J].International Journal of Oncology,2018,52(4):1350-1362
[15]Zhang B,Fang C,Deng D,et al.Research progress on common adverse events caused by targeted therapy for colorectal cancer[J].Oncology Letters,2018,16(1):27-33
[16]Limagne E,Euvrard R,Thibaudin M,et al.Accumulation of MDSCand Th17 cells in patients with metastatic colorectal cancer predict the efficacy of a FOLFOX-bevacizumab drug treatment regimen[J].Cancer Research,2016,76(18):5241-5252
[17]Hong DS,Morris VK,El Osta B,et al.Phase IB Study of Vemurafenib in Combination with Irinotecan and Cetuximab in Patients with Metastatic Colorectal Cancer with BRAFV600EMutation[J].Cancer Discovery,2016,6(12):1352-1365
[18]A Passardi,O Nanni,D Tassinari,et al.Effectiveness of bevacizumab added to standard chemotherapy in metastatic colorectal cancer:final results for first-line treatment from the ITACa randomized clinical trial[J].Annals of Oncology,2016,26(6):1201-1207
[19]Williams C D,Grady W M,Zullig L L.Use of NCCN Guidelines,Other Guidelines,and Biomarkers for Colorectal Cancer Screening[J]J Natl Compr Canc Netw,2016,14(11):1479-1485
[20]Hong DS,Morris VK,El Osta B,et al.Phase IB Study of Vemurafenib in Combination with Irinotecan and Cetuximab in Patients with Metastatic Colorectal Cancer with BRAFV600EMutation[J].Cancer Discovery,2016,6(12):1352-1365
[21]Toden S,Tran HM,TovarCamargo OA,et al.Epigallocatechin-3-gallate targets cancer stem-like cells and enhances 5-fluorouracil chemosensitivity in colorectal cancer[J].Gastroenterology,2016,7(13):16158-16171
[22]Remuzgomartínez S,Genre F,Lópezmejías R,et al.Decreased expression of methylene tetrahydrofolate reductase(MTHFR)gene in patients with rheumatoid arthritis[J].Clinical&Experimental Rheumatology,2016,34(1):106-110
[23]Yano S.Combined Therapy with Targeted Drugs in Lung Cancer[J].Gan to Kagaku Ryoho Cancer&Chemotherapy,2016,43(4):413-418
[24]Wang J,Luo L,Wang D,et al.Combination Adjuvant Chemotherapy with Targeted Drugs for Treatment of Colorectal Cancer:A Network Meta-Analysis[J].Journal of Cellular Biochemistry,2018,119(2):1521-1537
[25]Yadav M,Singh A K,Kumar H,et al.Epidermal growth factor receptor inhibitor cancer drug gefitinib modulates cell growth and differentiation of acute myeloid leukemia cells via histamine receptors[J].Biochim Biophys Acta,2016,1860(10):2178-2190
[26]Hung-Chih H,Kien T T,Lu Y J,et al.Mutations of KRAS/NRAS/BRAFpredict cetuximab resistance in metastatic colorectal cancer patients[J].Oncotarget,2016,7(16):22257-22270
[27]Magrini S M,Buglione M,CorvòR,et al.Cetuximab and Radiotherapy Versus Cisplatin and Radiotherapy for Locally Advanced Head and Neck Cancer:A Randomized Phase II Trial[J].Journal of Clinical Oncology,2016,34(5):427-435
[28]Arevalo J F,Lasave A F,Wu L,et al.Intravitreal bevacizumab for diabetic macular oedema:5-year results of the Pan-American Collaborative Retina Study group[J].British Journal of Ophthalmology,2016,100(12):1605-1610
[29]Zalcman G,Mazieres J,Margery J,et al.Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study(MAPS):a randomised,controlled,open-label,phase 3 trial[J].Lancet,2016,387(10026):1405-1414
[30]Hahn N M,Stadler W M,Zon R T,et al.Phase II Trial of Cisplatin,Gemcitabine,and Bevacizumab As First-Line Therapy for Metastatic Urothelial Carcinoma:Hoosier Oncology Group GU 04-75[J].Journal of Clinical Oncology,2016,29(12):1525-1530
[31]Tewari K S,Sill M W,Penson R T,et al.Bevacizumab for advanced cervical cancer:final overall survival and adverse event analysis of a randomised,controlled,open-label,phase 3 trial(Gynecologic Oncology Group 240)[J].Lancet,2017,390(10103):1654-1663
[2]Tan D,Fu Y,Su Q,et al.Prognostic role of platelet-lymphocyte ratio in colorectal cancer:A systematic review and meta-analysis[J].Medicine,2016,95(24):e3837
[3]Mlecnik B,Bindea G,Angell H K,et al.Integrative Analyses of Colorectal Cancer Show Immunoscore Is a Stronger Predictor of Patient Survival Than Microsatellite Instability[J].Immunity,2016,44(3):698-711
[4]Samawi H H,Shaheen A A,Tang P A,et al.Risk and predictors of suicide in colorectal cancer patients:a Surveillance,Epidemiology,and End Results analysis[J].Current Oncology,2017,24(6):e513-e517
[5]Dienstmann R,Vermeulen L,Guinney J,et al.Consensus molecular subtypes and the evolution of precision medicine in colorectal cancer[J].Nature Reviews Cancer,2017,17(2):79-92
[6]Huang Y Q,Liang C H,He L,et al.Development and validation of a radiomics nomogram for preoperative prediction of lymph node metastasis in colorectal cancer[J].Science Foundation in China,2016,34(4):2157-2164
[7]Lech G,S覥otwiński R,S覥odkowski M,et al.Colorectal cancer tumour markers and biomarkers:Recent therapeutic advances[J].World Journal of Gastroenterology,2016,22(5):1745-1755
[8]A Passardi,O Nanni,D Tassinari,et al.Effectiveness of bevacizumab added to standard chemotherapy in metastatic colorectal cancer:final results for first-line treatment from the ITACa randomized clinical trial[J].Annals of Oncology,2016,26(6):1201-1207
[9]Murcia O,Juárez M,Hernández-Illán E,et al.Serrated colorectal cancer:Molecular classification,prognosis,and response to chemotherapy[J].World Journal of Gastroenterology,2016,22(13):3516-3530
[10]Mcquade R M,Stojanovska V,Bornstein J C,et al.Colorectal Cancer Chemotherapy:The Evolution of Treatment and New Approaches[J].Current Medicinal Chemistry,2017,24(15):1537-1557
[11]Dong Z,Cui M Y,Peng Z,et al.Nanoparticles for Colorectal Cancer Targeted Drug Delivery and MR Imaging:Current Situation and Perspectives[J].Current Cancer Drug Targets,2016,16(6):536-550
[12]Banerjee A,Pathak S,Devi S V,et al.Strategies for targeted drug delivery in treatment of colon cancer:current trends and future perspectives[J].Drug Discovery Today,2017,22(8):1224-1232
[13]Wang J,Luo L,Wang D,et al.Combination Adjuvant Chemotherapy with Targeted Drugs for Treatment of Colorectal Cancer:A Network Meta-Analysis[J].Journal of Cellular Biochemistry,2018,119(2):1521-1537
[14]Tomida C,Yamagishi N,Nagano H,et al.VEGF pathway-targeting drugs induce evasive adaptation by activation of neuropilin-1/cMet in colon cancer cells[J].International Journal of Oncology,2018,52(4):1350-1362
[15]Zhang B,Fang C,Deng D,et al.Research progress on common adverse events caused by targeted therapy for colorectal cancer[J].Oncology Letters,2018,16(1):27-33
[16]Limagne E,Euvrard R,Thibaudin M,et al.Accumulation of MDSCand Th17 cells in patients with metastatic colorectal cancer predict the efficacy of a FOLFOX-bevacizumab drug treatment regimen[J].Cancer Research,2016,76(18):5241-5252
[17]Hong DS,Morris VK,El Osta B,et al.Phase IB Study of Vemurafenib in Combination with Irinotecan and Cetuximab in Patients with Metastatic Colorectal Cancer with BRAFV600EMutation[J].Cancer Discovery,2016,6(12):1352-1365
[18]A Passardi,O Nanni,D Tassinari,et al.Effectiveness of bevacizumab added to standard chemotherapy in metastatic colorectal cancer:final results for first-line treatment from the ITACa randomized clinical trial[J].Annals of Oncology,2016,26(6):1201-1207
[19]Williams C D,Grady W M,Zullig L L.Use of NCCN Guidelines,Other Guidelines,and Biomarkers for Colorectal Cancer Screening[J]J Natl Compr Canc Netw,2016,14(11):1479-1485
[20]Hong DS,Morris VK,El Osta B,et al.Phase IB Study of Vemurafenib in Combination with Irinotecan and Cetuximab in Patients with Metastatic Colorectal Cancer with BRAFV600EMutation[J].Cancer Discovery,2016,6(12):1352-1365
[21]Toden S,Tran HM,TovarCamargo OA,et al.Epigallocatechin-3-gallate targets cancer stem-like cells and enhances 5-fluorouracil chemosensitivity in colorectal cancer[J].Gastroenterology,2016,7(13):16158-16171
[22]Remuzgomartínez S,Genre F,Lópezmejías R,et al.Decreased expression of methylene tetrahydrofolate reductase(MTHFR)gene in patients with rheumatoid arthritis[J].Clinical&Experimental Rheumatology,2016,34(1):106-110
[23]Yano S.Combined Therapy with Targeted Drugs in Lung Cancer[J].Gan to Kagaku Ryoho Cancer&Chemotherapy,2016,43(4):413-418
[24]Wang J,Luo L,Wang D,et al.Combination Adjuvant Chemotherapy with Targeted Drugs for Treatment of Colorectal Cancer:A Network Meta-Analysis[J].Journal of Cellular Biochemistry,2018,119(2):1521-1537
[25]Yadav M,Singh A K,Kumar H,et al.Epidermal growth factor receptor inhibitor cancer drug gefitinib modulates cell growth and differentiation of acute myeloid leukemia cells via histamine receptors[J].Biochim Biophys Acta,2016,1860(10):2178-2190
[26]Hung-Chih H,Kien T T,Lu Y J,et al.Mutations of KRAS/NRAS/BRAFpredict cetuximab resistance in metastatic colorectal cancer patients[J].Oncotarget,2016,7(16):22257-22270
[27]Magrini S M,Buglione M,CorvòR,et al.Cetuximab and Radiotherapy Versus Cisplatin and Radiotherapy for Locally Advanced Head and Neck Cancer:A Randomized Phase II Trial[J].Journal of Clinical Oncology,2016,34(5):427-435
[28]Arevalo J F,Lasave A F,Wu L,et al.Intravitreal bevacizumab for diabetic macular oedema:5-year results of the Pan-American Collaborative Retina Study group[J].British Journal of Ophthalmology,2016,100(12):1605-1610
[29]Zalcman G,Mazieres J,Margery J,et al.Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study(MAPS):a randomised,controlled,open-label,phase 3 trial[J].Lancet,2016,387(10026):1405-1414
[30]Hahn N M,Stadler W M,Zon R T,et al.Phase II Trial of Cisplatin,Gemcitabine,and Bevacizumab As First-Line Therapy for Metastatic Urothelial Carcinoma:Hoosier Oncology Group GU 04-75[J].Journal of Clinical Oncology,2016,29(12):1525-1530
[31]Tewari K S,Sill M W,Penson R T,et al.Bevacizumab for advanced cervical cancer:final overall survival and adverse event analysis of a randomised,controlled,open-label,phase 3 trial(Gynecologic Oncology Group 240)[J].Lancet,2017,390(10103):1654-1663