从NCCN指南更新看靶向药物在结直肠癌肝转移新辅助治疗中的地位

The role of targeted drugs in the neoadjuvant chemotherapy for colorectal liver metastases: an update from the NCCN guidelines

手术切除是结直肠癌肝转移(CRLM)唯一有治愈可能的治疗方式,但有约70%的CRLM患者会在肝切除后出现复发。新辅助化疗是降低术后复发率并延长患者生存期的有效手段,靶向药物问世后更是以其高有效率而被广泛应用于新辅助治疗中。但是由于目前缺乏靶向药物在新辅助治疗中应用的临床证据,2017年新版NCCN指南将新辅助化疗联合靶向治疗的推荐修改为仅推荐新辅助单纯化疗。如何客观地看待NCCN指南推荐意见的变化对于指导临床实践具有重要意义。因此,本文将重点探讨靶向药物在新辅助治疗中的作用和地位。

Surgical resection is the only possible cure method for colorectal liver metastases （CRLM）, but about 70% of patients with CRLM will relapse after hepatectomy. Neoadjuvant therapy is an effective means to reduce the recurrence rate and prolong the survival of patients. The targeted drugs have also been widely used in neoadjuvant therapy for its high objective response rate. However, the new version of the NCCN guidelines in 2017 revised the recommendation of neoadjuvant chemotherapy combined with targeted therapy as a recommendation for neoadjuvant chemotherapy alone, due to the lack of clinical evidence. It was of great importance for clinical practice to take an objective view on the changes in the recommendations of the NCCN guidelines. Therefore, this article will focus on the role and status of targeted drugs in neoadjuvant therapy.