摘要
背景结直肠癌在发病初期并无明显的临床症状,在临床确诊时往往已处于病理晚期,发生了远处转移.结直肠癌最常见的远处转移器官是肝脏,研究发现,采用生物靶向药物联合FOLFIRI方案对发生肝转移患者可取得良好的疗效.目的探讨西妥昔单抗不同给药策略在RAS野生型结直肠癌(colorectal cancer,CRC)肝转移患者中的应用价值及安全性.方法选取2017-07/2019-03我院74例采用FOLFOX化疗方案治疗的RAS野生型CRC肝转移患者作为研究对象,根据西妥昔单抗给药策略分为2组,每组37例.单周组:首次予以400 mg/m^(2)西妥昔单抗,静脉滴注120 min,后续每周予以250 mg/m^(2)西妥昔单抗,1周/次;双周组:予以500 mg/m^(2)西妥昔单抗治疗,每2周重复.观察对比两组疾病缓解率、毒副反应发生率、生存质量改善率、生存情况及治疗前后基质金属蛋白酶(matrix metalloproteinase,MMPs)、miR-106b-5p、前列腺癌相关非编码RNA转录物1(PCAT-1)表达.结果双周组疾病缓解率78.38%高于单周组54.05%(P<0.05);双周组白细胞和/或中性粒细胞减少、口腔黏膜炎及痤疮样皮疹发生率均高于单周组(P<0.05);双周组MMP-2、MMP-9相对表达量均较单周组显著下降,基质金属蛋白酶组织抑制因子(tissue inhibitor of metalloproteinase,T1MP)表达量较单周组明显升高(P<0.05);单周组与双周组的miR-106b-5p、PCAT-1相对表达量均较治疗前显著下降,且双周组下降幅度更大(P<0.05);双周组生存质量改善有效率72.97%高于单周组48.65%(P<0.05);两组无进展生存时间相比,差异无统计学意义(P>0.05).结论西妥昔单抗双周给药治疗RAS野生型CRC肝转移患者缓解率、生存质量改善情况优于每周给药,但会增加患者不良反应发生率,实际可根据患者耐受情况选择治疗方案.
BACKGROUND Colorectal cancer(CRC)has no obvious clinical symptoms at the initial stage of the disease,and it is often diagnosed at an advanced stage of pathology,with distant metastasis.The most common target organ of distant metastasis in CRC is the liver,and patients with liver metastasis have been shown to be well treated with biologic targeted agents in combination with FOLFIRI regimen.AIM To evaluate the efficacy and safety of different administ-ration strategies of cetuximab in patients with RAS wild-type CRC with liver metastasis.METHODS From July 2017 to March 2019,74 patients with RAS wild-type CRC liver metastases treated with the FOLFOX regimen at our hospital were selected as the research subjects.According to the cetuximab administration strategy used,they were divided into either a weekly group or a bi-weekly group,with 37 cases in each group.The weekly group was initially given 400 mg/m^(2) cetuximab by intravenous infusion over 120 min,followed by 250 mg/m^(2) cetuximab once every week.The bi-weekly group was given 500 mg/m^(2) cetuximab once every 2 wk.The disease remission rate,the incidence of toxic and side effects,the improvement of quality of life,the survival,and the expression of matrix metalloproteinases(MMPs),miR-106b-5p,and prostate cancer-related non-coding RNA transcript 1(PCAT-1)before and after treatment were compared between the two groups.RESULTS The disease remission rate in the biweekly group was significantly higher than that of the weekly group(78.38%vs 54.05%,P<0.05).The incidence of leukopenia and/or neutropenia,oral mucositis,and acne-like rash in the biweekly group was significantly higher than that of the weekly group(P<0.05).The relative expression of MMP-2 and MMP-9 in the biweekly group was significantly lower than that in the weekly group,but the expression of tissue inhibitor of matrix metalloproteinases(T1MP)was significantly higher than that in the weekly group(P<0.05).The relative expression of miR-106b-5p and PCAT-1 after treatment was significantly lower in both groups,and the decrease was significantly greater in the bi-weekly group(P<0.05).The effective rate of improving the quality of life was significantly higher in the bi-weekly group than in the weekly group(72.97%vs 48.65%,P<0.05),though there was no statistically significant difference in the progression-free survival time between the two groups(P>0.05).CONCLUSION Cetuximab biweekly treatment of RAS wild-type CRC patients with liver metastases has better remission rate and quality of life improvement than weekly administration,but it increases the incidence of adverse reactions in patients.The administration strategy can be selected according to the patient’s tolerance.
作者
王超
李胜强
赵岩
Chao Wang;Sheng-Qiang Li;Yan Zhao(Clinical Laboratory,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300193,China)
出处
《世界华人消化杂志》
CAS
2022年第4期204-211,共8页
World Chinese Journal of Digestology
