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BACKGROUNDColorectal cancer (CRC) is the third leading cause of cancer-related death in males and females in the United States. Approximately, 20%-22% of patients have metastatic disease at the time of presentation, and 50%-60% will develop metastasis over the course of their disease. Despite advances in systemic therapies, there remains a paucity of effective third- and later-line therapies for patients with ongoing disease progression. However, rechallenging chemo-resistant CRC tumors with previously administered therapies is an emerging concept that may be a life-prolonging option for heavily treated metastatic colorectal cancer (mCRC).CASE SUMMARYA 41-year-old man with no previous medical history initially presented with worsening diffuse abdominal tenderness. Computed tomography was significant for a splenic flexure mass and hepatic lesions concerning for metastatic disease. He underwent a colectomy with anastomosis. Postoperative pathology was diagnostic for moderately to well-differentiated adenocarcinoma (T4bN1bM1a). He received adjuvant 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX), but therapy was discontinued due to the development of atrial fibrillation. Additional workup indicated a carcinoembryonic antigen level of 508.2 ng/mL, and mutational analysis found that the tumor was microsatellite instability-high and KRAS/BRAF wild-type. He was started on irinotecan with oxaliplatin (IROX), and bevacizumab (14 cycles), developed disease progression, was transitioned to FOLFOX and cetuximab, and then eventually three cycles of pembrolizumab. Following disease progression, he was rechallenged with IROX therapy, as he previously responded well to oxaliplatin-based therapy. The IROX rechallenge provided this patient with a ten-month survival benefit, decreased metastatic burden, and marked improvement in his clinical condition.CONCLUSIONRechallenge of previous lines of well-tolerated systemic chemotherapy regimens may be a valuable therapeutic strategy in patients with heavily-treated mCRC.  相似文献   
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摘 要 目的: 探讨1例伊立替康导致的迟发性腹泻。方法: 分析导致患者发生迟发性腹泻的原因,机制,遗传因素和治疗。结果: 迟发性腹泻是伊立替康的剂量限制性毒性,与其代谢产物7-乙基-10-羟基喜树碱(SN-38)的细胞毒性有关。基因多态性是伊立替康相关迟发性腹泻的重要因素之一。该患者腹泻的治疗方案安全有效,临床药师在治疗过程中发挥了重要作用。结论:加强伊立替康用药患者的药学监护十分重要。  相似文献   
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BackgroundThe present study sought to investigate the combined effects of cetuximab and irinotecan on colorectal cancer cells as well as the mechanisms underlying their anti-cancer effects.Material and methodsHigh performance liquid chromatography, Hoechst staining assay, and western blotting analysis were used to detect intracellular drug concentrations, cell apoptosis, and protein expression in the presence of cetuximab, irinotecan, and the combination of both.ResultsCetuximab was found to increase intracellular concentrations of irinotecan as well as cytotoxicity by inhibiting the epidermal growth factor receptor and, by extension, the downstream RAS-RAF-MEK-ERK signaling pathway. Cetuximab therefore induced apoptosis and improved the effect of irinotecan in colorectal cancer cells. It was also shown that cetuximab inhibited the drug efflux activity of ABCG2. In combination with irinotecan, cetuximab can both significantly induce cell apoptosis by inhibiting the RAS-RAF-MEK-ERK signaling pathway and improve the effects of irinotecan by decreasing drug efflux through the inhibition of ABCG2.ConclusionThese features contribute to its anti-cancer potential.  相似文献   
5.
欧松生  吴超扬 《吉林医学》2014,(20):4422-4423
目的:研究分析抗肿瘤药伊立替康应用于临床治疗小细胞癌的效果。方法:选择40例小细胞癌患者,随机分为观察组与对照组,每组20例。观察组患者采用伊立替康联合顺铂治疗,对照组采用依托泊苷治疗,观察比较两组患者的治疗有效率及其不良反应情况。结果:观察组的治疗有效率显著高于对照组的治疗有效率(P<0.05);观察组的不良反应发生率小于对照组的不良反应发生率,差异有统计学意义(P<0.05)。结论:临床使用抗肿瘤药伊立替康联合顺铂治疗小细胞癌的疗效显著,且不良反应少,值得临床推广和应用。  相似文献   
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1 例62 岁结肠癌男性患者,接受伊立替康80 mg 静脉滴注d1、d8 化疗.化疗后反复腹泻11 d,化疗第13 天腹泻加重伴发热,急诊入院.查血常规示WBC 0.34×109·L-1,NEUT 5.94%,L 85.34%,RBC 3.84×1012·L-1,Hb 114.0 g·L-1,PLT 33×109·L-1.BUN 13.71 mmol·L-1,Scr 291 μmol·L-1.给予头孢匹罗抗感染,重组人粒细胞集落刺激因子升白细胞,免疫调节,止泻、护肾、补液等对症治疗,入院第2 天出现感染性休克,给予抗休克等治疗.第3 天出现深度昏迷,血压难以维持.最终因循环、呼吸衰竭死亡.  相似文献   
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目的建立测定盐酸伊立替康注射液中盐酸伊立替康含量的高效液相色谱法。方法采用Agilent HC-C_(18)柱(250 mm×4.6 mm,5μm),以磷酸盐缓冲液(称取无水磷酸二氢钠2.43 g和辛烷磺酸钠1.66 g,溶于1 000 mL水中)-甲醇-乙腈(57:25:18)为流动相,柱温为40℃,流速为1.5 mL/min,检测波长为255 nm。结果盐酸伊立替康质量浓度在0.1831~1.464 7 g/L范围内与峰面积呈良好线性关系(r=0.9994,n=7),平均回收率为100.33%,RSD=0.46%(n=9)。结论该法准确、简便、重复性好,可用于盐酸伊立替康注射液的含量测定。  相似文献   
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Introduction

Chemoradiotherapy (CRT) is the standard treatment for locally advanced rectal cancer; however, the optimal chemotherapy sequence to administer simultaneously with radiotherapy remains unclear. We conducted a phase I/II study to test a new regimen, TEGAFIRI (combination tegafur, uracil [UFT], leucovorin [LV], irinotecan), for patients with locally advanced rectal cancer.

Patients and Methods

A total of 22 patients with locally advanced lower rectal adenocarcinoma were enrolled in the present study. The radiation dose was 50.4 Gy in 28 fractions. UFT (300 mg/m2/d) and LV (75 mg/body weight/d) were administered orally 3 times daily. Irinotecan was administered as an intravenous infusion at 3 escalating dose levels. The initial dose was 50 mg/m2 (level 1; n = 7), the intermediate was 70 mg/m2 (level 2; n = 8), and the maximum was 80 mg/m2 (level 3; n = 7). The drug was administered on days 1, 15, 29, and 43.

Results

Dose-limiting toxicity was not observed at any dosing level. The most frequent adverse event was leukopenia (50%), followed by diarrhea (45.5%), anal pain (31.8%), and neutropenia (27.3%). All were well-managed with the appropriate drugs. The total pathologic complete response rate was 22.7%, and the proportion of good responders was 28.6%, 50%, and 71.4% at levels 1, 2, and 3, respectively. None of the patients experienced local recurrence. The 5-year relapse-free and overall survival rates were 80.4% and 80.8%, respectively.

Conclusion

TEGAFIRI is a promising CRT regimen that results in marked tumor regression and good local control. Moreover, its adverse events are well-tolerated.  相似文献   
9.
化疗是转移性结直肠癌(mCRC)的主要治疗手段,伊立替康是mCRC的重要药物,但其存在治疗有效率有限、毒副反应个体差异大的问题。因此需要寻找有效的生物学标志物,筛选出对治疗反应性好、耐受性好的个体以指导临床治疗。尿苷二磷酸葡萄糖醛酸转移酶1A(UGT1A)的基因多态性与伊立替康的毒性及疗效均密切相关,但现有研究结果不一致,预测作用存在争议。本文通过Pubmed检索基因多态性与伊立替康相关性的有关文献,综合分析了UGT1A预测伊立替康毒性局限性的原因,可能与人种差异、药物使用剂量不同及与其他化疗药物或靶向药物联合使用有关。UGT1A多位点基因多态性的检测或与羧酸酯酶(CES)、ATP结合盒子(ABC)转运体、CYP3A4、SCOL等多个基因多态性的联合检测可能是提高伊立替康毒性和疗效预测水平的方式之一。  相似文献   
10.
目的:观察和分析伊立替康治疗结直肠癌相关胆碱能综合征的发生情况.方法:应用2种FOLFIRI方案治疗转移性结直肠癌患者89例,观察和记录胆碱能综合征发生情况,并将其与患者临床资料、其他不良反应和所应用的治疗方案进行相关性分析.结果:53例(59.6%)患者发生胆碱能综合征,中位发生时间为伊立替康开始滴注后150min(30min-25h),绝大多数在用药后24h内逐渐消退,预防性应用阿托品可以有效预防胆碱能综合征发生;≥60岁老年患者胆碱能综合征明显高发(75.9%vs51.7%,P=0.029),未发现其与性别、ECOG评分等临床特征有关;出现胆碱能综合征患者迟发性腹泻有减少趋势(52.8%vs34.0%,P=0.077),未发现胆碱能综合征与其他不良反应相关;采用高剂量氟尿嘧啶治疗方案患者黏膜炎明显高发(50.0%vs27.5%,P=0.029).结论:伊立替康相关胆碱能综合征高发,应引起临床医生重视;胆碱能综合征对后续可能发生的迟发性腹泻和/或骨髓抑制无预测作用.  相似文献   
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