贝伐珠单抗联合化疗治疗晚期结直肠癌的疗效观察
Therapeutic effects of bevacizumab combined with chemotherapy regimens on metastatic colorectal cancer

摘要：目的 观察贝伐珠单抗联合化疗治疗晚期结直肠癌的近期疗效、安全性及远期生存期。方法 回顾性分析2008年6月～2013年12月应用贝伐珠单抗联合以奥沙利铂、伊立替康、氟尿嘧啶及其衍生物为基础的化疗方案，治疗51例晚期结直肠癌的临床疗效、生存分析以及贝伐珠单抗的不良反应。结果 完全缓解(CR)4例，部分缓解(PR)13例，疾病稳定(SD) 15例，疾病进展(PD)19例，有效率(ER)为33.33%，疾病控制率(DCR)为62.75%。一线治疗32例，ER为40.63%，DCR为75%；二线治疗19例，ER为21.05%，DCR为42.11%。贝伐珠单抗联合一线、二线化疗患者的ER差异无统计学意义(P>0.05)，但DCR差异有统计学意义(P=0.019)，贝伐珠单抗联合不同化疗方案及分别治疗结、直肠癌患者的ER和DCR差异均无统计学意义(P>0.05)。贝伐珠单抗联合一线化疗的无进展生存时间(PFS)明显优于联合二线化疗(P<0.001)，但总生存期(OS)差异无统计学意义(P=0.08)；贝伐珠单抗联合FOLFIRI、FOLFOX、XELOX及XELIRI方案的中位PFS及OS差异有统计学意义(P<0.001)，且以贝伐珠单抗联合以伊立替康为基础的化疗方案疗效更佳。贝伐珠单抗的不良反应主要有高血压7例(13.73%)、皮疹6例(11.76%)、蛋白尿2例(3.92%)、出血2例(3.92%)，绝大多数是可控制的。结论 贝伐珠单抗联合化疗治疗晚期结直肠癌患者的疗效是肯定的，贝伐珠单抗一线治疗的DCR及PFS均优于二线，且以贝伐珠单抗联合伊立替康为基础的化疗方案疗效更佳。
ABSTRACT: Objective To investigate the effects of bevaeizumab combined with chemotherapy regimens on short-term efficacy, safety and short-term survival of metastatic colorectal cancer (mCRC). Methods We made a retrospective analysis of efficacy and patient’s survival and adverse events of bevacizumab combined with chemotherapy regimens for 51 mCRC patients treated in the First Affiliated Hospital of Xi’an Jiaotong University from June 2008 to December 2013. Results Of the 51 patients with mCRC, 4 patients achieved complete response, 13 achieved partial response (PR), 15 had stable disease (SD) and 19 had progressive disease (PD), with an effective ness rate (ER) of 33.33% and disease control rate (DCR) of 62.75%. First- and second-line treatment or different chemotherapy regimen combined with bevacizumab did not significantly differ in ER (P>0.05). However, DCR of 32 patients who received first-line treatment of chemotherapy combined with bevacizumab was superior to that of the others who received second-line treatment of chemotherapy combined with bevacizumab (P=0.019). The median PFS of 32 patients who received first-line treatment of chemotherapy combined with bevacizumab was higher than that of the others who received second-line treatment of chemotherapy combined with bevacizumab (P<0.001); however, there were no significant difference in OS (P=0.08). The different chemotherapy of bevacizumab combined with FOLFOX regimen, FOLFIRI regimen, XELOX regimen or XELIRI regimen differed significantly in median PFS and OS (P<0.001). The adverse events related to bevacizumab included hypertension (7 cases, 13.73%), skin eruption (6 cases, 11.76%), proteinuria (2 cases, 3.92%) and bleeding (2 cases, 3.92%), most of which could be alleviated by drug treatment. Conclusion Bevacizumab combined with chemotherapy regimen is effective and well