K-ras基因突变型晚期大肠癌患者抗血管生成靶向治疗的近期疗效观察

The clinical effect of antiangiogenesis targeted therapy in advanced colorectal cancer patients with K-ras mutation

目的：观察贝伐珠单抗（BEV）联合化疗治疗K-ras基因突变型晚期大肠癌患者的疗效及安全性。方法：回顾性分析2008年1月–2014年1月我院收治的60例K-ras基因突变型晚期大肠癌病例,均接受贝伐珠单抗联合化疗治疗,根据RECIST标准评价疗效,并观察至肿瘤进展时间（TTP）及不良反应。结果：60例病例中,总客观缓解率（ORR）为23.3%,总疾病控制率（DCR）为85.0%,其中一线、二线靶向治疗的ORR分别为30.3%、16.0%;一线、二线靶向治疗的DCR分别为87.9%、84.0%;60例患者中有12例初次使用贝伐珠单抗治疗进展后,更改化疗方案并继续使用贝伐珠单抗治疗的患者,其ORR、DCR分别为8.3%、75.0%;贝伐珠单抗联合具体的化疗方案近期疗效中,FOLFIRI＋BEV较FOLFOX＋BEV的客观缓解率高（27.6%vs 20.0%）,但无统计学差异,而疾病控制率方面差异亦不显著（89.7%vs 86.7%）。60例患者中,共进展37例,TTP为1.4~13.4个月,m TTP为5.4个月（95%CI 3.9~6.8个月）。结论：对于K-ras基因突变型晚期大肠癌患者,贝伐珠单抗联合化疗有一定的有效率,且一线应用有效率更高,不良反应发生率低,患者耐受性较好。

Objective： To investigate the efficacy and safety of bevacizumab （BEV） combined with chemotherapy in advanced colorectal cancer patients with K-ras mutation. Methods： Sixty patients diagnosed as advanced colorectal cancer with pathology confirmed K-ras mutation from January 2008 to January 2014 in our hospital were analyzed retrospectively. All patients were received the treatment of bevacizumab combined with different chemotherapy. The efficacy was evaluated according to RECIST standards. Time to progression （TTP） and adverse effects were also observed. Results： Among the 60 patients, the objective response rate （ORR） was 23.3%, the disease control rate （DCR） was 85.0%; the ORRs for the first and second line targeted therapy were 30.3% and 16.0%, respectively. The DCRs for the first and second line targeted therapy were 87.9% and 84.0%, respectively. The ORR and DCR of 12 patients was 8.3% and 75.0% respectively, who continuously received BEV and switched chemotherapy after disease progression. The ORR was higher in patients treated with FOLFIRI plus BEV while comparing with that of patients treated with FOLFOX plus BEV （27.6% vs 20.0%）, however, there was no significant difference; no significant difference was observed in DCR either （89.7% vs 86.7%）. Disease progression was observed in 37 patients and the TTP ranged from 1.4 to 13.4 months. The median TTP was 5.4 months （95%CI 3.9 - 6.8 months）. Conclusion： Bevacizumab combined chemotherapy, especially used as first line, showed good efficiency and was well tolerated in advanced colorectal cancer patients with K-ras mutation.