FOLFOX 4方案联合西妥昔单抗新辅助治疗大肠癌肝转移的临床观察

Clinical observation of cetuximab combined with FOLFOX 4 regimen as neo-adjuvant therapy for colorectal cancer with liver metastases

目的观察西妥昔单抗联合FOLFOX 4方案新辅助治疗大肠癌肝转移的疗效及安全性。方法收集2009年11月至2011年11月共18例大肠癌肝转移患者,采用西妥昔单抗(400mg/m2静滴,第1周,维持剂量为250mg/m2静滴,每周1次,共6周)联合FOLFOX 4方案(奥沙利铂85mg/m2静滴,d1;亚叶酸钙200mg/m2静滴,d1、d2;氟尿嘧啶400mg/m2静推,d1、d2,继以600mg/m2持续静滴22h,d1、d2,14天为1周期)治疗,3个周期评价疗效。结果全组均可评价疗效,获PR 15例、SD 2例、PD 1例,有效率为83.3%,疾病控制率为94.4%。18例患者均接受了手术,同期进行大肠癌根治术+肝转移灶切除14例,分期切除4例。原发灶R0切除18例;转移灶R0切除15例,R1切除3例。18例患者的中位总生存时间(OS)为30.4个月,中位无进展生存期(PFS)为21.2个月。主要不良反应为3级皮肤痤疮样皮疹及1～2级中性粒细胞减少和延迟性腹泻。结论 FOLFOX 4方案联合西妥昔单抗新辅助治疗大肠癌肝转移安全有效,并能够提高手术切除率,延长生存时间,为大肠癌肝转移提供了新的治疗策略。

Objective To evaluate the efficacy and adverse reaction of cetuximab combined with FOLFOX 4 regimen as neo- adjuvant therapy for colorectal cancer with liver metastases. Methods A total of 18 patients with liver metastases from colorectal canc- er were treated with cetuximab combined with FOLFOX 4 regimen. Cetuximab 400mg/m2 was intravenously given at the first dose and maintenance at 250mg/m2 every week for a total of 6 weeks. FOLFOX 4 regimen was given as follows： oxaliplatin 85mgc/m2 iv, dl; calcium folinate 200mg/m2 iv, d1 , d2 ; fluorouracil 400mg/m2 bolus, d1 , d2 , and then 600mg/m2 civ for 22h, d1 , d2 , 2 weeks was a cycle. The efficacy were evaluated after 3 cycles. Results The efficacy could be evaluated in eighteen patients, with PR in 15 cases, SD in 2 cases, and PD in 1 case. The response rate was 83.3% and the disease control rate was 94.4%. Eighteen patients received surgery, 14 of them underwent synchronous radical colorectal surgery and liver metastases resection, and 4 cases received stage opera- tion. R0 resection of primary lesion was performed in 18 patients, while R0 resection of liver metastases was operated in 15 cases and Rt resection in 3 cases. The median overall survival was 30. 4 months, and the median progression-free survival was 21.2 months. The adverse reaction during the treatment included grade 3 skin toxicity, grade 1-2 delayed diarrhea and grade 1-2 neutropenia. Conclusion FOLFOX 4 regimen combined with cituximab neo-adjuvant therapy for colorectal cancer with liver metastases is effective and well-to- larable, which can increase the resectabiliy rate and prolong patients＇ survival, may provide a new treating strategy for colorectal cancer with liver metastases.