晚期结直肠癌化疗的研究进展

随着细胞毒药物和分子靶点药物的发展,晚期结直肠癌患者姑息化疗的有效率以及生存期取得了瞩目的成效,患者中位生存期可超过2年。本文通过比较单药化疗与联合化疗以及不同联合化疗方案的优劣,分析卡培他滨能否替代5-FU的作用;阐述打打停停(stop-and-go)的化疗观念,介绍贝伐单抗和西妥昔单抗这两种分子靶点药物在晚期结直肠癌患者中的疗效。旨在对这些问题的综述来阐明奥沙利铂或伊立替康联合5-FU/LV优于5-FU/LV单药;FOLFOX或FOLFIRI联合方案均可作为晚期结直肠癌可耐受化疗患者的一线化疗方案,疾病进展后可互换作为二线方案;卡培他滨可代替5-FU/LV与奥沙利铂联合作为晚期结直肠癌患者的一线化疗方案,但卡培他滨与伊立替康联合不是一个理想的方案;在转移性结直肠癌的化疗中不建议完全停止化疗,可考虑使用5-FU/LV单药维持;贝伐单抗和西妥昔单抗这两种分子靶点药物联合化疗均可有效的提高生存期。从而概述晚期结直肠癌化疗的一些新进展。

Progression in palliative chemotherapy for advanced colorectal cancer

Due to the rapid development in cytotoxic agents and molecular target drugs,the response rate of advanced colorectal cancer patients has been elevated,and the overall survival has been prolonged. Some clinical trials even lead the median survival beyond 2 years. This article focused on the following issues: comparing single agent chemotherapy and combined chemotherapy,comparing different combined chemotherapy regimens,exploring the possibility of replacing 5-fluorouracil (5-FU) with capecitabine,introducing the stop-and-go conception,and analyzing the roles that molecular target agents,including Bevacizumab and Erbitux,have taken. The elucidation of above issues revealed that the efficacy of combined chemotherapy on advanced colorectal carcinoma is better than that of single agent therapy; both FOLFOX and FOLFIRI regimens are recommended as first-line chemotherapy,and can be crossed over as second-line chemotherapy; capecitabine can effectively replace 5-FU infusion while combined with oxaliplatin,but may not be a good option with irinotecan; available data support a stop-and-go strategy in metastasic colorectal Earcinoma if enough chemotherapy is given before stop; both Bevacizumab and Erbitux are active in improving the survival and response rate.