中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2018, Vol. 40 ›› Issue (5): 660-666.doi: 10.3881/j.issn.1000-503X.10125

• 论著 • 上一篇    下一篇

西妥昔单抗治疗KRAS或全RAS野生型转移性结直肠癌的疗效及预后分析

吴夕1,邓冰彬2,白春梅1,赵林1,程月鹃1,李孝远1,李宁宁1,周建凤1()   

  1. 1中国医学科学院 北京协和医学院 北京协和医院肿瘤内科,北京 100052
    2苏州大学附属第二医院放疗科,江苏苏州 215000
  • 收稿日期:2017-10-26 出版日期:2018-10-30 发布日期:2018-11-07
  • 通讯作者: 周建凤 E-mail:ZhouJF@pumch.cn
  • 基金资助:
    中国医学科学院医学与健康科技创新工程(2016-I2M-1-001)

Efficacy and Prognostic Factors of Cetuximab Therapy in Treating KRAS or All RAS Wild-type Metastatic Colorectal Cancer

WU Xi1, DENG Bingbin2, BAI Chunmei1, ZHAO Lin1, CHENG Yuejuan1, LI Xiaoyuan1, LI Ningning1, ZHOU Jianfeng1()   

  1. 1 Department of Medical Oncology,PUMC Hospital,CAMS and PUMC,Beijing 100052,China
    2 Department of Radiotherapy and Oncology,the Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215000,China
  • Received:2017-10-26 Online:2018-10-30 Published:2018-11-07
  • Contact: Jianfeng ZHOU E-mail:ZhouJF@pumch.cn
  • Supported by:
    Supported by the CAMS Innovation Fund for Medical Sciences(2016-I2M-1-001)

摘要:

目的 探索影响西妥昔单抗治疗KRAS或全RAS野生型转移性结直肠癌(mCRC)患者疗效及预后的因素。方法 从北京协和医院肿瘤内科2007年11月至2016年12月病理确诊为mCRC并行基因检测为KRAS野生型(2013年11月前)或全RAS野生型(2013年11月后)的患者中,筛选出接受西妥昔单抗联合化疗至少2周期的病例,回顾性分析临床病理特征与疗效的关系。结果 共入组60例患者,其中一线接受西妥昔单抗治疗34例,客观缓解率(ORR)为55.9%,中位无进展生存期和总生存期(OS)分别为10和24个月。一线治疗患者中,全RAS野生型较仅KRAS野生型者疾病进展风险降低69.5%(P=0.012),左半结肠癌ORR明显高于右半结肠癌(62.1%比0;χ 2=5.46,P=0.033)。一线治疗疾病缓解或稳定的8例患者跨线使用西妥昔单抗时中位OS可达35.0(95%CI:23.6~46.4)个月。 结论 全RAS野生型、左半部位mCRC患者一线应用西妥昔单抗时疗效更优。一线获益患者继续跨线应用西妥昔单抗生存时间长。

关键词: 转移性结直肠癌, RAS基因, 西妥昔单抗, 疗效, 预后

Abstract:

Objective To explore the efficacy and prognostic factors of cetuximab therapy for KRAS or all RAS wild-type(WT)metastatic colorectal cancer(mCRC).Methods We screened mCRC patients receiving at least two cycles of cetuximb and chemotherapy from those with KRAS WT(before November 2013)or all-RAS-WT(after November 2013)in the Department of Medical Oncology,Peking Union Medical College Hospital from November 2007 to December 2016. The relationship between the clinicopathological characteristics and the efficacy was retrospectively analyzed.Results A total of 60 patients were included. For the 34 patients receiving cetuximab as first-line treatment,the objective response rate(ORR)was 55.9%,and the progression-free survival and overall survival(OS)was 10 and 24 months,respectively. All-RAS-WT mCRC had significantly lower risk of progression than those with KRAS-only-WT(P=0.012),and left-sided colorectal cancer had higher ORR than right-sided colon cancer(62.1% vs. 0,P=0.033)during the first-line treatment. The median OS of the eight patients continuing cetuximab beyond first-line progression was 35.0(95%CI:23.6-46.4)months.Conclusions The efficacy of cetuximab for left-sided colorectal cancer was better than for right-sided colon cancer,and patients with all-RAS-WT have lower risk of progression than those with KRAS-only-WT. Patients benefiting from first-line cetuximab and continuing cetuximab beyond progression survive longer.

Key words: metastatic colorectal cancer, RAS gene, cetuximab, efficacy, prognosis

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