奥沙利铂或伊立替康联合氟尿嘧啶类药物一线治疗<i>k</i>-<i>ras</i>突变型晚期结直肠癌的疗效分析_West China Medical Journal

Authors：

 夏学明 , 闫晓杰 , 房慧 , 刘钦兰 ,  白莉

中国人民解放军总医院肿瘤内一科（北京 100853）;

Corresponding author：

白莉, Email: baili_0795@163.com

Keywords：

k-ras突变; 伊立替康; 奥沙利铂; 氟尿嘧啶; 晚期结直肠癌

DOI：

10.7507/1002-0179.20150364

Video：

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目的分析奥沙利铂或伊立替康联合氟尿嘧啶类药物一线化学治疗（化疗）k-ras 突变型晚期结直肠癌的疗效和安全性。方法收集2008年1月-2014年2月收治、经病理确诊的74例k-ras 基因突变型晚期结直肠癌患者，分别使用奥沙利铂（50例）85 mg/m² 第1天或伊立替康（24例）180 mg/m² 第1天，联合氟尿嘧啶（5-Fu）400 mg/m² 静脉推注第1天+5-Fu 2 400 mg/m² 持续静脉滴注46 h +亚叶酸钙400 mg/m² 第1天，14 d 为1个周期或口服卡培他滨1.0 g/m²，2次/d，第1～14天，21 d 为1个疗程。结果 74例患者可评价疗效，奥沙利铂组和伊立替康组的有效率分别为20.0%和12.5%，疾病控制率分别为80.0%和83.3%，中位无进展生存时间分别为8.0个月[95%CI（6.0，10.0个月）和6.7个月[95%CI（6.2，7.2）个月]，两组间差异均无统计学意义（P＞0.05）。两组患者不良反应易耐受，主要为骨髓抑制和胃肠道反应。结论 k-ras 基因突变型晚期结直肠癌患者，在一线化疗方面奥沙利铂方案较伊立替康方案能获得更高的有效率，同时在晚期结直肠癌的治疗中，检测k-ras 基因的状态不仅在抗EGFR 靶向治疗中有着重要的意义，对于一线化疗方案的选择也有着指导价值。

Citation： 夏学明, 闫晓杰, 房慧, 刘钦兰, 白莉. 奥沙利铂或伊立替康联合氟尿嘧啶类药物一线治疗k-ras突变型晚期结直肠癌的疗效分析. West China Medical Journal, 2015, 30(7): 1270-1273. doi: 10.7507/1002-0179.20150364 Copy

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1. 赖少清, 鞠凤环, 王贵齐, 等. 2004~2008年704例大肠癌临床流行特征[J]. 中国肿瘤, 2010, 19(2):111-113.
2. Jemal A, Siegel R, Ward E, et al. Cancer statistics[J]. JAMA, 2013, 310(9):982.
3. Meyerhardt JA, Mayer RJ. Systemic therapy for colorectal cancer[J]. N Engl J Med, 2005, 352(5):476-487.
4. Venook A. Critical evaluation of current treatments in metastatic colorectal cancer[J]. Oncologist, 2005, 10(1):250-261.
5. Benvenuti S, Sartore-Bianchi A, Di Nicolantonio F, et al. Oncogenic activation of the RAS/RAF signaling pathway impairs the response of metastatic colorectal cancers to anti-epidermal growth factor receptor antibody therapies[J]. Cancer Res, 2007, 67(6):2643-2648.
6. National Cancer Institute. Cancer therapy evaluation program. reporting guidelines:CTCAE V.3.0[EB/OL]. 2003[2014-05-01]. http://ctep.cancer.gov/forms.
7. Andreyev HJ, Norman AR, Cunningham D, et al. Kirsten ras mutations in patients with colorectal cancer:the multicenter "RASCAL" study[J]. J Natl Cancer Inst, 1998, 90(9):675-684.
8. Andreyev HJ, Norman AR, Cunningham D, et al. Kirsten ras mutations in patients with colorectal cancer:the "RASCAL Ⅱ" study[J]. Br J Cancer, 2001, 85(5):692-696.
9. Ahnen DJ, Feigl P, Quan G, et al. Ki-ras mutation and p53 overexpression predict the clinical behavior of colorectal cancer:a Southwest Oncology Group study[J]. Cancer Res, 1998, 58(6):1149-1158.
10. Nemunaitis J, Cox J, Meyer W, et al. Irinotecan hydrochloride (CPT-11) resistance identified by K-ras mutation in patients with progressive colon cancer after treatment with 5-fluorouracil (5-FU)[J]. Am J Clin Oncol, 1997, 20(5):527-529.
11. Richman SD, Seymour MT, Chambers P, et al. KRAS and BRAF mutations in advanced colorectal cancer are associated with poor prognosis but do not preclude benefit from oxaliplatin or irinotecan:results from the MRC FOCUS trial[J]. J Clin Oncol, 2009, 27(35):5931-5937.
12. Colucci G, Gebbia V, Paoletti G, et al. Phase Ⅲ randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer:a multicenter study of the Gruppo Oncologico Dell'Italia Meridionale[J]. J Clin Oncol, 2005, 23(22):4866-4875.

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奥沙利铂或伊立替康联合氟尿嘧啶类药物一线治疗k-ras突变型晚期结直肠癌的疗效分析

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