奥沙利铂和伊立替康治疗失败后转移性结直肠癌的化疗选择

Chemotherapy for metastatic colorectal cancer after failure of treatment with irinotecan and oxaliplatin

目的：通过回顾性分析奥沙利铂及伊立替康化疗失败的转移性结直肠癌化疗疗效，探索结直肠癌的解救化疗方案。方法：回顾2005年1月～2013年3月本院经奥沙利铂及伊立替康化疗失败的转移性结直肠癌患者37例，分析化疗的有效率（RR）及无进展生存（PFS）。结果：化疗总有效率13.51%（5/37），5例PR ，12例SD，20例PD；以培美曲塞为基础化疗方案总有效率略高于其他方案（17.64%vs.10.00%，P=0.64），未延长PFS（2.00个月vs.1.63个月，HR=0.79，95%CI：0.35～1.78，P=0.58）；以雷替曲塞为基础的化疗方案有效率略高于其他方案（16.67%vs.12.00%，P=0.34），未延长PFS（1.58个月vs.1.90个月，HR=2.24，95%CI：0.98～5.12，P=0.06）。结论：以培美曲塞或雷替曲塞为基础的联合化疗方案对奥沙利铂及伊立替康化疗失败的转移性结直肠癌患者有一定疗效，值得进一步开展临床研究。

Objective：This retrospective study aims to determine the efficacy of chemotherapy and improve a salvage chemother-apy agent for metastatic colorectal cancer （MCRC） after failure of treatment with irinotecan and oxaliplatin. Methods：Between Janu-ary 2002 and March 2013, 37 patients with metastatic MCRC who had progressed after treatment with irinotecan and oxaliplatin were analyzed for their response rate （RR） and progression-free survival （PFS）. Results：The overall RR of the 37 patients was 13.51%, with 5 cases of partial response （PR）, 12 cases of disease stabilization （SD）, and 20 cases of progression （PD）. Compared with other chemo-therapy regimens, treatment with a pemetrexed-based chemotherapy agent had a higher RR （17.64%vs. 10.00%, P=0.64） without a lon-ger PFS （2.00 months vs. 1.63 months, HR=0.79, 95%, CI：0.35 to 1.78, P=0.58）. Compared with other chemotherapy regimens, treat-ment with a raltirexed-based chemotherapy agent had a higher RR （16.67%vs. 12.00%, P=0.34） without a longer PFS （1.58 months vs. 1.90 months, HR=2.24, 95%, CI：0.98 to 5.12, P=0.06）.Conclusion：In patients with MCRC after failure of treatment with irinotecan and oxaliplatin, a pemetrexed-based or raltirexed-based chemotherapy agent may beneficial during salvage treatment and is therefore worthy of further study.