西妥昔单抗联合化疗在消化系统肿瘤中的临床应用

目的 评价西妥昔单抗联合化疗治疗消化系统肿瘤的疗效和安全性.方法 回顾性分析行西妥昔单抗联合化疗的35例结直肠癌(CRC)、11例进展期胃癌(AGC)和3例其他消化系统肿瘤患者的临床资料,观察其疗效和不良反应.结果 全组可评价疗效者共37例.CRC中,可评价疗效者29例,其有效率(RR)为24.1%(7/29),疾病控制率(DC)为75.9%(22/29);其中一线治疗的RR为36.4%,DC 为90.9%;二线治疗的RR为20.0%,DC 为70.0%;三线及以上治疗的RR 为12.5%,DC 为62.5%.AGC中,可评价疗效者6例,其中一线治疗的2例患者均获部分缓解,二线治疗完全缓解和病情稳定者各1例,三线及以上治疗病情进展者2例.不良反应以皮疹、恶心、呕吐以及粒细胞下降多见.全组皮疹的发生率为79.6%,其中重度皮疹占8.2%.CRC的疗效与皮疹分级相关.结论 西妥昔单抗联合化疗在CRC中安全有效,一线治疗疗效最佳,其疗效与皮疹分级相关;在AGC治疗中也有应用前景.

Cetuximab in combination with chemotherapy for patients with gastrointestinal cancer

Objective To evaluate the efficacy and safety of cetuximab in combination with chemotherapy for gastrointestinal cancers. Methods The data of 35 colorectal cancers (CRC), 11 advanced gastric cancers (AGC) and 3 other gastrointestinal cancers treated with cetuximab in combination with chemotherapy were retrospectively reviewed, and the efficacy and adverse events were analyzed. Results Of the 49 patients, 37 were evaluable. Twenty-nine CRC were evaluated by RECIST criteria with a PR rate of 24.1%, SD rate of 51.8% and disease control rate (DC) of 75.9%. Subgroup analysis showed that the response rate (RR) and DC rate were 36.4% and 90.9% for the first-line therapy, 20.0% and 70.0% for the second-line therapy, 12.5% and 62.5% in the heavily pre-treated cases, respectively. Six patients with AGC were assessed for efficacy, including 2 PR for first-line therapy, 1 CR and 1 SD for second-line therapy, and 2 with progressive disease in the heavily pre-treated cases. Rash was observed in 79.6% of the patients with a grade 3 rate of 8.2%, and the severity was relevant to the DC. Grade 3 or 4 neutropenia was observed in 16.3%, and grade 3 infusion related reaction (IRR) happened in 4.1% (2 cases). Conclusion Cetuximab combined with chemotherapy is safe and effective for patients with gastrointestinal cancer. In colorectal cancers, the combination therapy shows a high disease control rate, especially in first-line therapy. The severity of rash may be parallel with efficacy. The combination therapy is also promising in the treatment of AGC.