分子靶向药物给药模式对转移性结直肠癌患者生存的影响

摘要

目的：探讨两种不同类型靶向药物在不同给药模式下对转移性结直肠癌（ mCRC）患者生存的影响。方法回顾性分析135例接受过分子靶向治疗mCRC患者的临床病理特征、靶向治疗情况及随访资料，比较不同种类靶向药物及不同线数化疗联合靶向治疗对生存期（ OS）的影响。结果全组中接受抗EGFR单抗者、接受贝伐珠单抗者及接受抗EGFR单抗＋贝伐珠单抗者的中位OS依次为20�7、24�4和41�6个月，接受两种靶向药物者比仅接受一种靶向药物者的中位OS有明显延长（ P＜0�05）；一线化疗未联合靶向治疗者的中位OS为30�8个月，与一线化疗联合靶向治疗者的21�5个月相比，差异无统计学意义（ P＞0�05）；三线及以上联合靶向治疗者的中位OS为37�0个月，高于三线前均联合靶向治疗者的13�7个月，差异有统计学意义（ P＜0�05）；接受过三种化疗药物（伊立替康、奥沙利铂、氟尿嘧啶）及贝伐珠单抗和抗EGFR单抗两种靶向药物的患者中，三线及以上使用靶向者的中位OS为50�6个月，与三线前使用靶向者的41�6个月比较，差异无统计学意义（ P＞0�05）。结论接受过两类靶向药物治疗的mCRC患者比仅接受一类靶向药物者可能获得更好生存获益。患者使用靶向药物的时机并非越早越好，肿瘤生物学行为较好的患者更适合先化疗后靶向的治疗模式。%Objective To explore the influence of anti-VEGF monoclonal antibody and anti-EGFR monoclonal antibody on survival of patients with metastatic colorectal cancer ( mCRC) under different administration patterns. Methods In a retrospective study, the clinical characteristics, targeted therapy and follow-up data were analyzed among 135 mCRC patients ever treated with mo-lecular targeted therapies. The medium overall survival( OS) was compared among different kinds of targeted drugs and different lines of chemotherapy plus targeted therapy. Results Among mCRC patients, the medium OS for patients receiving anti-EGFR monoclonal an-tibody, bevacizumab or anti-EGFR monoclonal antibody plus bevacizumab were 20�7, 24�4 and 41�6 months, respectively. The medi-um OS was significantly longer in mCRC patients receiving anti-EGFR monoclonal antibody plus bevacizumab than anti-EGFR mono-clonal antibody or bevacizumab alone(P<0�05). The medium OS for patients receiving chemotherapy alone as first-line treatment or first-line chemotherapy plus molecular targeted therapies were 30�8 and 21�5 months, respectively( P>0�05) . The medium OS for pa-tients receiving monoclonal antibody after second-line therapy was 37�0 months, higher than 13�7 months for patients receiving chemo-therapy plus monoclonal antibody therapy for either first-line or second-line option with significant difference( P<0�05) . Among patients ever treated with irinotecan, oxaliplatin, fluorouracil, anti-EGFR monoclonal antibody and bevacizumab, the medium OS for patients receiving chemotherapy plus monoclonal antibody used after third-line therapy was 50�6 months, similar with the 41�6 months for pa-tients receiving chemotherapy plus monoclonal antibody used before third-line therapy( P>0�05) . Conclusion Patients ever receiving both bevacizumab and anti-EGFR monoclonal antibody therapies had better survival than those who received either bevacizumab or anti-EGFR monoclonal antibody therapy. Earlier introduction of monoclonal antibody might not associate with better survival. Patients with good tumor biological behavior might benefit from the treatment pattern of chemotherapy before monoclonal antibody.