曲氟尿苷替匹嘧啶在晚期大肠癌后线治疗中的探索

Exploration of trifluridine tepyrimidine in the after-line treatment of advanced colorectal cancer

目的分析曲氟尿苷替匹喘睫在晚期大肠癌后线治疗效果。方法回顾性收集在2020年6月-2021年6月我院晚期大肠癌13名患者的资料,这些患者均接受白蛋白紫杉醇+曲氟尿昔替匹喀喘+免疫检查点抑制剂+抗血管药物的治疗方案,主要的疗效观察指标包括客观缓解率、无进展生存期和总生存。结果13名患者中仅有2名患者出现客观缓解(ORR=15.4%,95%CI:1.9%-45.4%),10名患者在接受治疗后得到疾病控制(DCR=76.9%,95%CI:46.2%-95.0%)。整体人群中位随访时间337d(范围:166-8664),中位PFS为134<1(95%CI:105.8-162.2d);ECOG=1分的患者接受该治疗方案的无进展生存期明显长于ECOG=2分的患者(ECOG=1分:179d vs ECOG=2分:126d,p=0.04,HR=0.38,95%CI:0.12 to 1.2).最常见的不良事件为骨髓抑制、手脚麻木、手足综合征、恶心、食欲减退、乏力和血压升高,其中绝大多数为1-2级。有4名患者出现≥3级白细胞/中性粒细胞减少。结论白蛋白紫杉醇+曲氟尿昔替匹喀睫+免疫检查点抑制剂+抗血管药物的联合方案后线治疗微卫星稳定的大肠癌其总体效果仍然有限(对照既往多项的历史数据,疗效提升并不明显),但本研究结果提示未来在扩大样本量的基础之上,可针对体能状况较好的患者探索强强联合的治疗方案。

Objective To analyze the effects of trafluricline tepyrimidine in the after-line treatment of advanced colorectal cancer.Methods The data of 13 patients with advanced colorectal cancer in our hospital from 2020 June to 2021 June were retrospectively collected,and these patients received albumin paclitaxel+trafluidine tepitipimidine+immune checkpoint inhibitors+anti vascular drugs,and the main efficacy observation indicators included objective response rate,progression-free sundval and overall survival.Results Only two of the 13 patients experienced objective response(ORR=15.4%,95%CI:1.9%-45.4%),and 10 patients received disease control after treatment(DCR=76.9%,95%CI:46.2%-95.0%).The median follow-up time for the overall population was 337 days(range:166 to 866 days)and the median PFS was 134 days(95%CI:105.8 to 162.2 days);Patients with EC0G=1 had significantly longer progression-free survival than patients with ECOG=2(EC0G=1 point:179d vs ECOG=2 points:126 days,p=0.04,HR=0.38,(95%CI:0.12 to 1.2)).The most common adverse events were bone marrow suppression,numbness of hands and feet,hand-foot syndrome,nausea,loss of appetite,fatigue,and increased blood pressure,the vast majority of which were grade 1 to 2.Four patients developed grade>leukopenia/neutropenia of grade 3.Conclusion The overall effect of the combination regimen of albumin paclitaxel+trifluridine tepyrimidine+immune checkpoint inhibitor+antivascular drugs in the treatment of microsatellite-stable colorectal cancer is still limited(compared with the previous historical data,the efficacy improvement is not obvious),but the results of this study suggest that on the basis of expanding the sample size in the future,a strong combination of treatment can be explored for patients with better physical status.