Activity of oxaliplatin plus capecitabine (CapeOx) with lapatinib for metastatic colorectal cancer: results from two patients treated on a clinical study.

摘要

Colorectal cancer is the third most commonly diagnosed malignancy and the third leading cause of cancer death in the United States. Ninety-four percent of cases are adenocarcinomas, and more than half of patients have locoregionally advanced or metastatic disease at the time of diagnosis. Of those who undergo surgery for localized disease, 30-50% recur either locally or with metastatic disease in the liver (20-70%) and/or lung (10-20%).Recent advances in chemotherapy for metastatic colorectal cancer (mCRC) have included the introduction of oxaliplatin and irinotecan-based regimens as first-line treatment. Median overall survival (OS) rates have improved from approximately 10 months with fluo-rouracil (5-FU) alone to 20 months or more with newer regimens. Additional improvement in progression-free survival (PFS) and objective response rate (ORR) has been seen with the addition of cetuximab to the 5-FU, leucovorin, and irinotecan (FOLFIRI) regimen in first-line treatment. The use of cetuximab-containing regimens for mCRC may be further refined by testing tumors for KRAS mutations, as cetuximab appears to work exclusively against tumors with wild-type KRAS. Other advances include the addition of the anti-VEGF agent bevacizumab (Avastin, Genentech) to existing chemotherapy regimens. Adding bevacizumab to the 5-FU, leucovorin, and irinotecan (IFL) regimen resulted in a significant improvement in median OS in one large study. In another study, the addition of bevacizumab to 5-FU, leucovorin, and oxaliplatin (FOLFOX) improved PFS in the treatment of mCRC, though no benefit was seen in OS.