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The role of biologic targets in metastatic colorectal cancer in non-elderly patients: A single institutional analysis

ANNALS OF ONCOLOGY(2020)

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摘要
The paradigm for the treatment of metastatic colorectal cancer (mCRC) has shown great advances in recent years. With the increasing use of targeted therapies, including epidermal growth factor receptor (EGFR) and anti-vascular endothelial growth factor (VEGF) antibody, the median overall survival (OS) of mCRC has been raised to approximately 30 months over the last 10 years [1]. Hence, for patients whose tumors are RAS wild-type, anti-EGFR monoclonal antibodies (cetuximab, panitumumab) have shown clinical efficacy. Study aims were to I) describe pts with mCRC; II) assess overall survival (OS) at 1 and 2 years of pts that underwent target therapy or chemotherapy alone. We performed retrospective and descriptive analysis of patients under 65 years old with mCRC from January 2013 to December 2017. Data were processed using SPSS®. Survival rate was evaluated using the Kaplan-Meier estimator with log-rank test. There were 54 pts with mCRC under 65 years old. Median age at diagnosis was 57 [24-65] years old; 55,6% (30/54) were male. Twenty-seven (50%) of pts were KRAS/NRAS wild-type and 81,5% of those received anti-EGFR, cetuximab, as first-line therapy, associated to FOLFIRI or FOLFOX. Eleven (32,3%) patients were prescribed bevacizumab in first-line and one (2,9%) patient was prescribed panitumumab associated to FOLFOX. In the second line, 6 patients that had cetuximab as first-line treatment switched to bevacizumab associated with FOLFOX or FOLFIRI and 5 patients continued with cetuximab associated with FOLFIRI or FOLFOX. In the third line, 5 patients that received second-line chemotherapy plus bevacizumab had a rechallenge with cetuximab plus irinotecan with a median time of treatment of 1,4 months. Twenty pts (37%) had 5-FU + Irinotecan/oxaliplatin based chemotherapy alone. According to BRAF mutation status, only one patient with RAS wild-type had the mutation V600E in BRAF gene. All the others were BRAF and RAS wild-type. High level of microsatellite instability (MSI-high) was observed in 2 patients and another 2 had a low level of microsatellite instability (MSI-low). All other patients tested were MSI stable (MSS). Median follow-up was 27 months. In the group of patients that made target therapy, survival rate at 1 year was 82,4% and 61,5% at 2 years. In the other group of patients, survival rate at 1 year was 63,5% and 42,4% at 2 years (HR 0,833, IC: 0,407-1,703, p=0,613). Although there is no significant difference between the two groups, survival rate at 1 and 2 years was superior in the group of patients that made target therapy.
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关键词
metastatic colorectal cancer,colorectal cancer,biologic targets,non-elderly
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