贝伐珠单抗联合FOLFIRI方案治疗晚期结肠癌的临床观察

Clinical Observation of Bevacizumab Combined with FOLFIRI Plan in the Treatment of Advanced Colon Cancer

目的:观察贝伐珠单抗联合伊立替康+亚叶酸钙+氟尿嘧啶(FOLFIRI)方案治疗晚期结肠癌的疗效、毒副反应及患者生存率。方法:选择我院肿瘤科2010年1月-2014年8月收治的113例晚期结肠癌患者作为研究对象,按照随机数字表法分为观察1组(40例)、观察2组(39例)和对照组(34例)。3组化疗方案均为FOLFIRI方案,观察1组、2组在此基础上分别联用贝伐珠单抗注射液5、7.5 mg/kg,14 d为1个周期,均治疗8个周期。比较3组患者的临床疗效,治疗前后血管内皮生长因子A(VEGF-A)阳性率、免疫指标(T细胞亚群中CD3+、CD3+CD4+、CD3+CD8+细胞所占比例)、毒副反应发生率及1年/2年生存率。结果:观察1组、2组患者的临床总有效率均显著高于对照组,VEGF-A阳性率均显著低于对照组,差异均有统计学意义(P<0.05)。3组患者CD3+、CD3+CD4+、CD3+CD8+所占比例均较治疗前显著降低,但观察1组、2组患者的显著高于对照组,差异均有统计学意义(P<0.05)。观察1组及对照组患者的高血压(3~4级)发生率均显著低于观察2组,观察1组和观察2组患者的白细胞减少(3~4级)发生率均显著低于对照组,差异均有统计学意义(P<0.05)。3组患者1年生存率比较,差异无统计学意义(P>0.05);观察1组、2组患者的2年生存率均显著高于对照组,差异有统计学意义(P<0.05)。结论:不同剂量贝伐珠单抗联合FOLFIRI方案治疗晚期结肠癌均有明显增效作用,可有效抑制VEGF-A,并发挥免疫保护和抗毒副作用,延长患者生存期;低剂量贝伐珠单抗的高血压发生率更低,安全性更高。

OBJECTIVE：To observe therapentic efficacy of bevacizumab combined with irinotecan ＋ leucovorin ＋ fluorouracil（FOLFIRI）plan in the treatment of advanced colon cancer,toxic reaction and patients＇ survival rate. METHODS：A total of 113 patients with advanced colon cancer admitted to the oncology department in our hospital from Jan. 2010 to Aug. 2014 were randomized into observation group 1（40 cases）,observation group 2（39 cases） and control group（34 cases）. Three groups received FOLFIRI;observation group 1 and 2 were additionally given Bevacizumab injection 5 and 7.5 mg/kg 14 d as a treatment course,for 8 cycles. Clinical efficaices as well as the positive rate of VEGF-A,immune indexes（the proportion of CD3＋,CD3＋CD4＋,CD3＋CD8＋in T cell subset）before and after treatment,the incidence of toxic reaction,1-year and 2-year survival rates were compared among 3 groups. RESULTS：The total response rate of observation group 1 and 2 were significantly higher than control group,and the positive rate of VEGF-A in observation group 1 and 2 were significantly lower than control group,with statistical significance（P〈0.05）. The proportion of CD3＋,CD3＋CD4＋and CD3＋CD8＋in 3 groups were significantly lower than before treatment,but observation group 1 and 2 were significantly higher than control group,with statistical significance（P〈0.05）. The incidence of grade hypertension（grade 3-4）in observation group 1 and control group were lower than observation group 2;the incidence of leucopenia（grade 3-4）in observation group 1 and 2 were significantly lower than control group,with statistical significance（P〈0.05）.There was no statistical significance in 1-year survival rate among 3 groups（P〈0.05）. 2-year survival rate of observation group 1and 2 were significantly higher than control group,with statistical significance（P〈0.05）. CONCLUSIONS：For advanced colon cancer,different doses of bevacizumab combined with FOLFIRI have significant synergistic effect,can effectively inhibit VEFG-A,play a role of immune protection and anti-toxic side effects,and prolong the survival time. The incidence of hypertension in patients treated with low-dose bevacizumab is relatively lower and the safety is better.