贝伐单抗治疗转移性结直肠癌20例近期疗效观察

将病理学证实的60例转移性结直肠癌患者随机分为两组,观察组20例予贝伐单抗（Avastin）联合伊立替康（CPT-11）、醛氢叶酸（LV）和5-氟尿嘧啶（5-Fu）,对照组40例予CPT-11联合LV和5-Fu治疗,至少化疗2个周期。观察近期疗效、不良反应和血清肿瘤标志物变化。结果观察组和对照组有效率分别为45％和35％（P〉0．05）;疾病控制率分别为80％和50％（P〈0．05）;肿瘤标志物治疗后均明显降低（P〈0．01）;两组不良反应多为Ⅰ～Ⅱ度,发生率无统计学差异（P〉0．05）。认为贝伐单抗联合伊立替康治疗转移性结直肠癌效果好,不良反应轻,值得临床借鉴。     

贝伐单抗联合化疗治疗进展期转移性结直肠癌临床观察

目的评价贝伐单抗联合IFL方案（伊立替康、氟尿嘧啶、亚叶酸钙）治疗进展期结直肠癌的疗效及安全性。方法回顾性总结2007年6月～2009年8月期间分别给予贝伐单抗联合IFL方案（A组,40例）和单独IFL方案（B组,37例）进行化疗患者治疗后有效率、不良反应、治疗前后肿瘤标志物的变化和随访情况。结果A组和B组的有效率分别为40．0％和21．6％;所有患者治疗前后肿瘤标志物浓度均有明显变化（P〈0．05）,A组和B组比较差异具有统计学意义（P〈0．05）,两组不良反应为Ⅰ～Ⅱ度,无严重不良反应,且差异无统计学意义（P〉0．05）;A组患者1年存活率为27．5％,其中生存期（OS）最长者达15．6个月,中位疾病进展期（TTP）为4．9个月,中位OS为10．5个月。B组患者1年存活率为18．9％,其中OS最长者达12．3个月,中位TTP为3．4个月,中位OS为8．8个月。两组1年存活率、中位TTP、中位OS比较,差异均具有统计学意义（P〈0．05）。结论与单独使用IFL方案相比,贝伐单抗联合化疗对于进展期转移性结直肠癌治疗具有良好的效果,多数患者不良反应为轻到中度,毒副作用发生率低,患者能够耐受,能明显延长患者的生存期。     

雷替曲塞联合西妥昔单抗或贝伐珠单抗治疗晚期结直肠癌临床疗效

目的 对比雷替曲塞联合西妥昔单抗或贝伐珠单抗治疗晚期结直肠癌的临床疗效。方法 80例晚期结直肠癌患者根据治疗方法的不同,采用随机数字表法分为两组各40例,甲组采用雷替曲塞联合西妥昔单抗治疗,乙组采用雷替曲塞联合贝伐珠单抗治疗,分析两组临床疗效,检测两组癌胚抗原(CEA)、鳞状细胞癌抗原(SCC),评估两组卡氏功能状态(KPS)评分,对比两组1年生存期、疾病进展时间、不良反应发生率。结果 治疗后,甲组临床总有效率稍低于乙组,差异无统计学意义(P>0.05);两组血清CEA、SCC水平较治疗前明显降低(P<0.05),而组间对比无统计学差异(P>0.05);两组KPS评分较治疗前明显升高(P<0.05),而组间对比无统计学差异(P>0.05);两组1年生存期、疾病进展时间、不良反应发生率,差异无统计学意义(P>0.05)。结论 雷替曲塞联合西妥昔单抗或贝伐珠单抗对晚期结直肠癌患者均有明显的临床疗效,且疗效相当,能减少不良反应发生,并提高患者生存质量,降低血清肿瘤标志物水平。     

贝伐珠单抗联合化疗治疗晚期大肠癌的临床疗效

目的:探讨对晚期大肠癌患者采用贝伐珠单抗联合化疗治疗的临床效果.方法:随机选取大连医科大学附属第一医院收治的178例晚期大肠癌患者,按照实际治疗方案分为观察组85例和对照组93例,观察组患者给予贝伐珠单抗联合化疗治疗,对照组患者给予XELOX方案治疗,比较两组患者的近期疗效、不良反应发生情况以及治疗后的生活质量.结果:观察组患者临床疗效显著优于对照组(67.06%vs 47.31%),差异具有统计学意义(P<0.05);两组患者骨髓抑制、神经毒性、肠胃道反应、肝肾毒性及免疫系统障碍发生率比较(25.88%vs 26.88%、17.65%vs 20.43%、20.00%vs 23.66%、15.29%vs 11.83%、11.76%vs 8.60%),差异无统计学意义(P>0.05);观察组患者化疗后各项生活质量评分无明显变化,与化疗前比较(65.62分±3.34分vs 67.83分±4.06分、67.67分±3.46分vs 69.26分±3.98分、66.15分±3.52分vs 68.11分±3.96分、66.58分±3.51分vs 68.02分±4.02分、66.83分±3.55分vs 68.39分±3.81分,差异无统计学意义(P>0.05);对照组患者化疗后各项生活质量评分均显著下降,与化疗前比较(51.57分±3.26分vs 67.89分±4.11分、54.62分±3.31分vs 69.30分±3.89分、53.24分±3.28分vs68.15分±3.92分、52.26分±3.22分vs 67.97分±4.11分、53.16分±3.28分vs 68.41分±3.80分),差异有统计学意义(P<0.05).结论:对晚期大肠癌患者采用贝伐珠单抗联合化疗治疗,能有提高患者的近期疗效,不增加化疗不良反应,对患者生活质量影响较小,值得推广.     

贝伐珠单抗联合化疗治疗老年胃肠肿瘤的疗效

<正>目前我国老年胃肠肿瘤的患者明显增加,临床对不能手术者首选姑息化疗。由于老年胃肠肿瘤患者机体功能衰退,对化疗的耐受性较差,因此,研究在不增加化疗风险的前提下提高化疗效果,对于胃肠癌晚期老年患者具有重要意义。贝伐珠单抗作为一类抑制肿瘤血管生成的重组人源化单克隆抗体,已经在恶性肿瘤治疗中广泛应用〔1〕。本文旨在探讨贝伐珠单抗联合化疗在老年胃肠肿瘤患者中的可行性。1资料与方法1.1一般资料选取2012年3月至2013年6月在本院肿瘤     

贝伐单抗联合FOLFOX化疗在老年结直肠癌患者中的安全性和有效性

目的探讨贝伐单抗联合FOLFOX化疗在老年结直肠癌患者中的安全性和有效性。方法选择Ⅳ期结直肠癌患者198例,根据患者的年龄和贝伐单抗使用情况,将患者分为中青年贝伐单抗组(78例)、老年贝伐单抗组(59例)和老年对照组(61例)。主要观察指标为无进展生存期和2年死亡率;次要观察指标是健康相关的生存质量和严重并发症。结果与老年对照组相比,中青年贝伐单抗组和老年贝伐单抗组患者无进展生存期显著延长(P=0.006);2年死亡率显著降低(15.38%和20.34%vs.34.43%,P=0.015);健康相关的生存质量显著增高(73.14±14.25和72.98±12.04 vs.66.52±13.86,P=0.008)。三组患者临床并发症均无显著差异(P0.05)。结论贝伐单抗在老年结直肠癌患者中是安全有效的,显著改善了患者的无进展生存期、2年死亡率和健康相关的生存质量。     

贝伐单抗联合化疗一线治疗转移性结直肠癌疗效的Meta分析

目的系统评价贝伐单抗联合化疗一线治疗转移性结直肠癌患者对生存期的影响。方法利用万方、维普、CNKI、PUMED、EMBASE数据库,收集贝伐单抗联合化疗一线治疗转移性结直肠癌的随机对照试验,对纳入研究的方法学质量进行评价,以文献为基础采用固定效应模型或随机效应模型对中位总生存期（OS）、无进展生存期（PFS）进行Meta分析。结果共纳入5篇文献,包括1778例。Meta分析显示,与未联合贝伐单抗对照组比较,贝伐单抗联合化疗组的0s（Z=2．55,P=0．01）和PFS（Z=11．96,P〈0．01）明显延长。结论贝伐单抗联合化疗一线治疗转移性结直肠癌可延长患者OS、PFS。     

热灌注基础上腹腔内贝伐珠单抗联合化疗治疗恶性腹水的临床观察

目的观察在热灌注的基础上腹腔内注射贝伐珠单抗(安维汀)联合腔内化疗治疗恶性腹水患者的疗效和安全性。方法 57例恶性腹水患者在热灌注的基础上随机分为腔内贝伐珠单抗联合化疗治疗组(治疗组)和腔内单纯化疗治疗组(对照组)。治疗前均先排尽腹水,以43～45.0℃灭菌0.9%生理盐水注入腹腔,持续有效循环40 min以上,排尽灌注液后治疗组在腹腔内注入贝伐珠单抗300 mg和氟尿嘧啶1 g。对照组除不加入贝伐珠单抗外,其余同治疗组。结果在可评价的57例患者中,治疗组总有效率为85.71%,对照组58.62%,P<0.05。全组患者耐受良好,无严重不良反应。结论热灌注基础上腹腔内贝伐珠单抗联合化疗治疗恶性腹水优于腔内单纯化疗且安全可靠。     

贝伐单抗靶向治疗结直肠癌的临床研究进展

分子靶向治疗已成为结直肠癌治疗的有效策略。最近，血管生成抑制疗法日益成熟，针对血管内皮生长因子（VEGF）的重组人源化单克隆抗体贝伐单抗（bevacizumab，商品名：Avastin，阿瓦斯丁^TM）成为结直肠癌治疗研究的热点。美国食品药品管理局（FDA）于2004年批准贝伐单抗为晚期结直肠癌的一线用药，     

卡培他滨与贝伐单抗联合治疗老年转移性结直肠癌的近期疗效及安全性

目的探讨卡培他滨与贝伐单抗联合治疗老年转移性结直肠癌的近期疗效及安全性。方法选取我院收治的老年性结直肠癌患者作为研究对象,将所有患者随机分为观察组和对照组,对照组患者采用卡培他滨联合奥沙利铂治疗,观察组患者采用卡培他滨联合贝伐单抗治疗,观察两组患者经4个周期治疗后的疗效、不良反应。结果两组的近期疗效比较,观察组有明显的优势(P<0.05)。两组不良反应比较,观察组较对照组具有明显优势(P<0.05)。结论卡培他滨联合贝伐单抗是治疗老年转移性结直肠癌的有效方法。     

内镜下射频热疗联合局部化疗治疗晚期大肠癌的随机对照研究

目的：探讨射频加局部化疗治疗晚期大肠癌的疗效,并与单纯射频治疗比较。方法选择晚期大肠癌失去手术切除时机患者55例行射频加局部化疗或单纯射频治疗,随机分为射频加局部化疗组（A组）27例、射频组（B组）28例,观察两组患者5年内肠梗阻缓解率、再转移率、生存率。结果 A组与B两组1～5年肠梗阻缓解率分别为88.9%vs 70.8%、95.8 vs 70%、89.5%vs 52.9%、100%vs 33.3%、100%vs 0,具有统计学差异（P＜0.05）;5年内再转移情况,A组27例无一例出现再转移,再转移率为0（0/27）,B组11例出现了新的转移病灶,再转移率为39.3%（11/28）,有统计学差异（P＜0.05）;A组5年生存率为44.4%（19/27）,B组为无一例生存,有统计学差异（P＜0.05）。结论内镜下射频热疗联合局部化疗能显著提高晚期大肠癌患者5年内肠梗阻缓解率和5年生存率,显著降低再转移率。     

Standard chemotherapy with cetuximab for treatment of colorectal cancer

AIM: To review and assess the evidence related to cetuximab treatment in metastatic colorectal cancer(mCRC) with regard to KRAS status.METHODS: PubMed, EMBASE, Cochrane database and American Society of Clinical Oncology meeting abstracts were searched for randomized controlled trials(RCTs) reporting the effect of KRAS status on efficacy of chemotherapy regimen with or without cetuximab in mCRC. Baseline information such as sex and age was summarized from the included studies.Hazard ratios of progression-free survival(PFS) and overall survival(OS) as well as objective response based on KRAS status were extracted for analysis.RESULTS: A total of 8 RCTs with 6780 patients were included. The combined analysis showed that cetuximab failed to improve the OS and PFS in patients with mCRC.However, in subgroup analysis, the pooled data showed that addition of cetuximab to irinotecan containing chemotherapy regimen was sufficient to improve OS and PFS in wild-type KRAS mCRC patients, but not in patients with mutant-type KRAS. The addition of cetuximab increased the incidence of adverse events such as diarrhea, rash, skin toxicity/rash, and nausea and vomiting. There was no significant publication bias existing in the included studies.CONCLUSION: The clinical benefit of cetuximab was only confirmed in patients with wild-type KRAS. KRAS status could be considered a biomarker of efficacy of cetuximab.     

Systemic and targeted therapy for advanced colon cancer

Colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer-related death in the USA. Prognosis is best when the disease is detected early; however, nearly two-thirds of newly diagnosed cases of CRC have lymph node involvement or metastatic disease. For years, 5-fluorouracil (FU)-based regimens represented the only viable treatment option for patients with metastatic CRC. However, in recent years several newer agents have been added to the treatment arsenal for this disease. These agents include oxaliplatin, irinotecan and newer monoclonal antibodies targeting the epidermal growth factor receptor (cetuximab and panitumumab) and VEGF (bevacizumab). This review aims to discuss current systemic and targeted therapies for metastatic colon cancer with a focus on mechanism of action, indications, toxicity and efficacy.     

New drugs for colorectal cancer (irinotecan, oxaliplatin, raltitrexed) meet expectations in routine practice: a single center's experience before and after their introduction

Background and Aims: Treatment of metastatic colorectal cancer with new drugs (NDs) as oxaliplatin and irinotecan had improved response and survival. In order to check whether the promising achievements of the trials are obtained in routine clinical practice, we have reviewed retrospectively our results for two periods, before (period A: 1993–1995, n=63) and after (period B: 1998–2000 n=103) the introduction of these NDs. Patients characteristics, treatment modalities, survival, and prognostic factors were compared. Patients: There were 74 women and 92 men, aged 60.8 ±11.6 yr, 7 patients received best supportive care only, 91 had synchronous metastasis. Results: Period B patients were older, with WHO score >1 more often, more adjuvant treatment, more metachronous metastasis, and NDs used more frequently (24% vs 59%). Median survival was similar (16 vs 15 mo). But when looking at the population aged <75 years with WHO score <2, median survival was 13 mo (period A) vs 21 mo (period B); survival at 1,2, and 3 yr were respectively 59.5±8%, 16.2±6%, 13.5±6% vs 69.8±6%, 49.6±7%, 29.8±7%, p<0.01). In multiparametric analysis, factors correlated with survival were the absence of elevated serum alkaline phosphatase, a unique metastatic organ, and administration of NDs. Conclusion: In our routine clinical experience the use of NDs for metastatic CRC has allowed a significant improvement in survival among patients with unresectable tumors.     

Increasing underrepresentation of elderly patients with advanced colorectal or non-small-cell lung cancer in chemotherapy trials

Background: Elderly patients are underrepresented in chemotherapy trials for advanced colorectal cancer (CRC) and non‐small‐cell lung cancer (NSCLC). However, the change in underrepresentation over time has not been documented. Aims: This study aimed to quantify (i) the change in the median age of patients enrolled in clinical trials for metastatic CRC and NSCLC between 1982–1991 and 1992–2001 compared with the general colorectal and lung cancer population, and (ii) the proportion of trials with an upper age limit for eligibility. Methods: A retrospective review of data from the Victorian Cancer Registry and all large published randomized chemotherapy trials for advanced CRC and NSCLC between 1982 and 2001 was conducted. Results: The median age of patients with CRC enrolled in clinical trials remained constant between the two decades (62.0 and 62.2 years), whereas the median age of the CRC population increased from 68.4 to 70.2 years, increasing the median age difference from 6.4 to 8.0 years. The median age of patients with lung cancer in clinical trials increased from 59.8 to 61.8 years, whereas the median age of the lung cancer population increased from 67.4 to 70.4 years, widening the age difference from 7.6 to 8.6 years. More trials set an upper age limit for eligibility in the first decade than in the second decade for both CRC (51 vs 29%, P = 0.04) and NSCLC (68 vs 41%, P = 0.03). Conclusion: International clinical trials for CRC and NSCLC are becoming increasingly unsuitable for application to Australian patients because of the increasing age discrepancy, despite fewer trials restricting eligibility by age.     

The efficacy and safety of bevacizumab combined with FOLFOX regimen in the treatment of advanced colorectal cancer: A systematic review and meta-analysis

Background:It is necessary to systematically evaluate the clinical efficacy and safety of bevacizumab (BEV) combined with 5-fluorouracil + leucovorin + oxaliplatin (FOLFOX) regimen in the treatment of advanced colorectal cancer.Methods:We searched the PubMed et al databases for randomized controlled trials (RCTs) on the BEV combined with the FOLFOX regimen in the treatment of advanced colorectal cancer up to January 20, 2021. The Cochrane Collaborations’ risk of bias tool was used for the quality assessment of included RCTs. Revman5.3 software was used for meta-analysis.Results:Eleven RCTs with a total of 3178 patients with advanced colorectal cancer were included, meta-analysis results showed that the objective response rate (odds ratio [OR] = 3.15, 95% confidence intervals [CI]: 2.25–4.40, P < .001) and cancer control rate (OR = 2.73, 95% CI: 1.91–3.90, P < .001) of BEV + FOLFOX were higher than that of FOLFOX group. And the incidence of gastrointestinal adverse reactions (OR = 1.29, 95% CI: 1.07–1.55, P = .008) in the BEV + FOLFOX group was higher than that of the FOLFOX group, there were no significant differences in the incidence of leukopenia (OR = 1.04, 95% CI: 0.72–1.50, P = .83), hypertension (OR = 3.92, 95% CI: 0.81–18.88, P = .09) and neurotoxicity (OR = 1.00, 95% CI: 0.8–1.27, P = .98) between the 2 groups.Conclusion:BEV combined with the FOLFOX regimen is more effective than the FOLFOX regimen alone in the treatment of advanced colorectal cancer, but it may also increase the risk of gastrointestinal adverse reactions.     

Neoadjuvant intra-arterial versus intravenous chemotherapy in colorectal cancer

To investigate the clinical benefits of transcatheter arterial infusion chemotherapy compared with intravenous chemotherapy in patients with colorectal cancer (CRC).From May 2013 to March 2018, 83 patients (50 men and 33 women) with surgically proven CRC were retrospectively included. Before surgery, 62 patients received conventional systemic chemotherapy, and 21 transcatheter arterial chemotherapy. Basic characteristics, disease control rate (DC), adverse reactions, postoperative complications, and toxicity profiles were collected and compared between the 2 groups.The sigmoid colon (43.37%) was the most common primary tumor location, and the least was the transverse colon (6.02%). Most lesions invaded the subserosa or other structures T3-4 (78.31%), and other lesions invaded the muscular layer T1-2 (21. 69%). The overall DC was 80.65% in the intravenous chemotherapy group and 90.48% in the arterial chemotherapy group (P < .05). Adverse events included myelosuppression and gastrointestinal reactions such as nausea, vomiting, diarrhea, abnormal liver function, and neurotoxicity, which were significantly less common in the intra-arterial group than in the intravenous group (P < .05). Postoperative complications included abdominal infection (11.29% vs 14.29%), intestinal obstruction (6.45% vs 4.76%), anastomotic bleeding (1.61% vs 0.00%), and anastomotic fistula (6.45% vs 4.76%) in the intravenous and intra-arterial groups, respectively (P > .05).Preoperative transcatheter arterial infusion chemotherapy is a safe and effective neoadjuvant chemotherapy measure for CRC with fewer adverse reactions and a higher overall DC.