卡培他滨或贝伐单抗用于结直肠癌维持治疗的回顾性分析

Efficacy of maintenance therapy with capecitabine versus bevacizumab for colorectal cancer

目的分析卡培他滨或贝伐单抗用于转移性结直肠癌维持治疗的疗效和安全性。方法回顾性分析2012年1月至2016年5月在我院病理诊断为"任何原发肿瘤"(primary tumor,T)、"任何区域淋巴结"(regional lymph nodes,N)、"远处转移"(distant metastasis,M)1期(TXNXM1)的结直肠癌接受维持治疗的患者病例资料。予以一线标准方案化疗,待病情缓解或稳定后,按照维持治疗方案的不同分为卡培他滨维持治疗组和贝伐单抗维持治疗组,评价两组患者维持治疗的疗效及不良事件。结果本研究共纳入病例66例,卡培他滨组41例,贝伐单抗组25例。卡培他滨维持化疗组中位无疾病进展生存时间(progression-free survival,PFS)为5.6个月,贝伐单抗维持治疗组中位PFS为7.7个月,两组比较无统计学差异(HR:1.171,95%CI:0.701~1.966,P>0.05)。卡培他滨维持治疗组中位总生存时间(overall survival,OS)为28.2个月,贝伐单抗维持治疗组中位OS为31.9个月,两组比较无统计学差异(HR:1.143,95%CI:0.602~2.180,P>0.05)。两组均无Ⅳ级不良事件发生,卡培他滨维持治疗组手足综合征发生率较高(P<0.05),贝伐单抗维持治疗组出血发生率较高(P<0.05),其他不良反应差异无统计学意义(P>0.05)。结论贝伐单抗用于转移性结直肠癌维持治疗相较卡培他滨显示出更长的疾病控制时间和总生存时间,但无统计学差异;有出血风险的患者建议选择卡培他滨进行维持化疗。

Objective To assess the clinical efficacy and safety of capecitabine versus bevacizumab for maintenance therapy in patients with metastatic colorectal cancer. Methods This retrospective comparative study was conducted among patients with pathologically confirmed metastatic colorectal cancer in stage TXNXM1 treated in Southwest Hospital between January,2012 and May,2016. The patients receiving XELOX/FOLFOX ± bevacizumab chemotherapy with subsequent partial response（ PR） or stable disease（ SD） were identified and divided into two groups according to the maintenance therapy（ capecitabine versus bevacizumab） they received until progression or intolerance. The efficacy and adverse events were compared between the two groups. Results A total of 66 cases were included in the analysis,including 41 in capecitabine group and 25 in bevacizumab group. In capecitabine group,maintenance therapy resulted in a median progression-free survival（ PFS） of 5. 6 months,as compared to 7. 7 months in bevacizumab group（ HR = 1. 171,95% CI： 0. 701-1. 966,P = 0. 211）. The median overall survival（ OS） of the patients was28. 2 months in capecitabine group and 31. 9 months in bevacizumab group,showing no significant difference between the two groups（ HR = 1. 143,95% CI： 0. 602-2. 180,P = 0. 441）. No grade 4 adverse events occurred in the two groups,but a higher incidence of extremities syndrome in capecitabine group（ P = 0. 026）and a higher incidence of bleeding in beacizumab group（ P = 0. 043） were recorded; the incidences of other adverse events were similar between the two groups（ P〉0. 05）. Conclusion Compared with capecitabine,bevacizumab for maintenance therapy achieves a longer disease control time and a longer overall survival time in patients with metastatic colorectal cancer, although such differences are not statistical significant.Maintenance chemotherapy with capecitabine is recommended for patients at risk of bleeding.