帕尼单抗与西妥昔单抗联合伊立替康治疗KRAS野生型转移性结直肠癌患者的疗效分析

Panitumumab compared with cetuximab-irinotecan therapy in patients with KRAS wild-type metastatic colorectal cancer

目的比较帕尼单抗与西妥昔单抗联合伊立替康疗法对KRAS野生型转移性结直肠癌患者的疗效。方法纳入KRAS野生型转移性结直肠癌患者35例，采用随机数字表法进行分组，随机分配方案隐藏，分别给予表皮生长因子受体抑制剂帕尼单抗（20例）和西妥昔单抗联合伊立替康（15例）治疗；统计学分析两组治疗方案疗效的差异。结果帕尼单抗组和西妥昔单抗联合伊立替康组部分缓解的患者分别为5例（25.0%）和4例（26.7%），差异无统计学意义（P=0.64）；两组患者中位总生存期分别为8.3个月和8.5个月，差异无统计学意义（χ2=1.161，P=0.13）；多因素分析表明两种治疗方案对患者总生存期的影响差异无统计学意义（HR=1.17，95%CI为0.68～2.04，χ2=1.01，P=0.47）；两组不良反应发生率分别为95%和100%（P=0.72）。结论帕尼单抗与西妥昔单抗联合伊立替康疗法对KRAS野生型转移性结直肠癌患者治疗效果类似，可以作为对化疗抵抗结直肠肿瘤患者的三线治疗药物在临床上推广。

ObjectiveTo compare the curative effect of KRAS wildtype metastatic colorectal cancer patients treated with either single agent panitumumab or combination therapy with cetuximab and irinotecan. MethodsUsing the random number table method （concealment of allocation）, the study enrolled 35 patients with KRAS wildtype metastatic colorectal cancer, who had received epidermal growth factor receptor inhibitor, either panitumumab （20 cases） or combination cetuximabirinotecan （15 cases）. The differences of curative effect between groups were assessed by statistical analysis. ResultsFive （25.0%） panitumumab and four （26.7%） cetuximabirinotecantreated patients had partial response, and the difference was not statistically significant （P=0.64）. Median overall survival was 8.3 months for the panitumumab group and 8.5 months for the cetuximabirinotecan group （χ2=1.161, P=0.13）. Multivariate analysis demonstrated that survival outcomes were similar regardless of the therapy selected and the difference was not statistically significant （HR=1.17, 95%CI： 0.682.04, χ2=1.01, P=0.47）. 95% patients who received panitumumab and all cetuximabirinotecantreated patients （100%） experienced treatmentrelated adverse events （P=0.72）. ConclusionThe drug therapy of panitumumab and cetuximabirinotecan treatment were similar to KRAS wildtype metastatic colorectal cancer patients and can be reasonable used as thirdline treatment options for patients with chemoresistant metastatic colorectal neoplasms.