厄洛替尼联合贝伐单抗一线治疗晚期非小细胞肺癌的疗效观察

目的:探讨联合使用厄洛替尼与贝伐单抗对晚期非小细胞肺癌的一线治疗效果及其不良反应,探索肺癌治疗新模式。方法:将选取的76例晚期未经治疗的非小细胞肺癌患者随机分为对照组(38例)和实验组(38例),其中对照组患者每日单纯给予150mg厄洛替尼治疗,实验组患者给予厄洛替尼联合贝伐单抗治疗,即厄洛替尼150mg/d,贝伐单抗15mg/kg。21d为1周期,对比观察两组患者无进展生存期(PFS),疾病控制率(DCR)、肿瘤客观缓解率(ORR)及毒副反应。结果:实验组患者治疗效果明显好于对照组,PFS:(15.7±1.5)月VS(8.1±0.9)月;DCR:92.10%VS 65.79%;ORR:65.78%VS 47.37%;毒副反应发生率:65.79%VS 94.74%。通过统计学方法进行检验分析,上述两组间的差异具有统计学意义(P<0.05)。结论:在厄洛替尼治疗中加用贝伐单抗可提高疗效,不良反应可耐受,值得在临床上推广。

临床护理干预对贝伐单抗玻璃体腔注射治疗老年性黄斑变性效果的影响

老年性黄斑变性（AMD）又称年龄相关性黄斑变性,是与年龄相关的致盲的重要眼病之一。进行性视力损害是该病的主要特征,大幅度的降低了老年人的生活质量,发病率在亚洲范围内呈现递增的趋势[1]。研究表明贝伐单抗可有效治疗AMD,贝伐单抗是一种重组人单克隆抗体,几乎拮抗所有的VEGF-A同源异构体,

影像生物标志物与贝伐珠单抗联合标准治疗对胶质母细胞瘤患者诊断及疗效的临床研究

目的：探讨影像生物标志物联合贝伐珠单抗在胶质母细胞瘤诊断及治疗中的应用价值。方法：选择我院收治的胶质母细胞瘤（GBM）患者38例,作为研究对象。采用随机数表法将其分为BEV组（n=20）与TMZ组（n=18）,所有患者均接受同步放化疗,BEV组患者采用贝伐珠单抗治疗,TMZ组选择替莫唑胺治疗,治疗后行DSC-MRI、DCE-MRI及PET检查,观察患者治疗前及治疗后各时间段影像生物标志物指标的变化,并统计两组患者治疗效果及生活质量。结果：两组患者近期疾病有效率、疾病控制率比较均存在显著差异（P〈0.05）;两组患者T0时刻rCBV、rCBF、Ktrans比较无显著差异,随着时间的延长,T1-T3时刻两组患者rCBV、rCBF、Ktrans均呈下降趋势,并且组间比较存在显著差异。结论：通过MRI检查观察胶质母细胞瘤患者影像生物标志物可初步判断患者病情程度,并且联合贝伐珠单抗治疗可准确评估患者病情改善程度,对指导临床治疗预后具有重要意义。

Does maintenance of Bevacizumab after treatment failure have a role in metastatic colon cancer?

Objective： To study the timing of Bevacizumab （BVC） in the overall treatment strategy of advanced metastatic colorectal cancer - early use （first-line） or later use. Methods： 41 patients with progressive metastatic colorectal carcinoma were included. Patients were randomized to receive chemotherapy with or without BVC. Primary end point was objective response. Secondary end points were median survival, time to tumor progression, and toxicity. Results： Partial response with second-line BVC group constituted 25% and 18.8% in patients with first-line chemotherapy and BVC-based regimen respectively, compared to 11.8% and 5.9% with second-line chemotherapy. Median time to progression was 3.1 vs. 2.3 months for cases with first-line chemotherapy and BVC-based regimens respectively. Median survival was 8.2 vs. 4 months in both groups respectively （P = 0.019）. Conclusion： Second-line chemotherapy combined BVC had higher disease control rate （partial response and stable disease）, median time to progression and median survival in BVC-naive patients compared to patients with first-line BVC-based therapy. BVC should be maintained in the second- and third-line settings, as cases with BVC discontinuation had significantly lower median time to disease progression and median survival. Selection of patients for use of BVC was recommended with taking into consideration the cost-benefit value and that the discontinuation of BVC would increase tumor progression.

Cost-utility of erlotinib combined with bevacizumab versus bevacizumab alone after completion of chemotherapy with bevacizumab for first-line treatment of advanced non-small-cell lung cancer

Bevacizumab plus erlotinib prolonged patients＇ progression-free survive （PFS） versus bevacizumab alone for the maintenance treatment of none-small cell lung cancer （NSCLC） in phase III clinical trial ATLAS （ClinicalTrials. gov identifier NCT00257608）, which repealed a benefit outcome and acceptable side-effects, but whether its cost performance would be accepted by patients is blurry. The aim of our research is to figure out which strategy is the best option in clinic and would spread broadly. Markov Model was used to calculate incremental cost-utility radios （ICURs） and 10-year quality-adjusted life years （QALY） of both strategies. The clinical data were collected from phase III clinical trial ATLAS （ClinicalTrials. gov identifier NCT00257608）. The cost data were obtained from Chinese health care system. In the research, one-way sensitivity analysis, probabilistic sensitivity analysis （PSA） and Monte-Carlo analysis were performed to test the stability of the results. The better strategy was bevacizumab alone strategy, and the cumulative costs of both strategies were $178 648.47 and $46 445.28, respectively, and the QALY was 12.506 and 10.643, respectively. The ICUR of combined application was $70 962.53/QALY, which was much higher than 3 times of mean gross domestic product （GDP） in China, suggesting that this strategy was no economical at all. In one-way analysis, the change of willingness-to-pay could not influence the consequence. In addition, in Monte-Carlo analysis, the probability distribution of cost, effectiveness and ICUR was in normal distribution. Taken together, bevacizumab alone strategy was the better strategy in terms of cost-effectiveness.

Combination therapy of cRGD-DOX self-assembled nanoparticles and bevacizumab for breast cancer

The interplay among diverse cell populations in the tumor microenvironment contributes to tumor progression.Targeting to different cell populations might result in improved therapeutic effects on malignant tumors.Integrins high express on many kinds of tumor cells,and VEGF has a strong effect on tumor angiogenesis.Therefore,based on tumor cells and angiogenesis,we fabricated integrin-targeting cRGD-DOX nanoparticles and combined them with the anti-VEGF antibody bevacizumab.We evaluated the antitumor effect of this combination therapy in an integrin-overexpressing MDA-MB-231 tumor model.The cRGD-DOX nanoparticles were effectively uptake by MDA-MB-231 cells and the uptake was related to the expression of integrinin;cRGD-DOX nanoparticles showed less cytotoxic than free DOX;Bevacizumab did not show significant cytotoxicity against MDA-MB-231 cells at concentrations less than 1 mg/mL.The in vivo results showed that bevacizumab could reduce tumor interstitial fluid pressure;the combination of bevacizumab and cRGD-DOX nanoparticles showed enhanced antitumor effects compared with the corresponding single-agent treatments.These findings suggested the combination of angiogenesis antibody and integrin-targeting nanoparticle loaded with a cytotoxic drug was a promising cancer treatment regimen.

Survival of patients with KRAS wild-type metastatic colorectal cancer is identical after sequential treatment with cetuximab and bevacizumab regardless of the sequence-A retrospective single-center study

Objective:To investigate the overall survival of patients with KRAS wild-type metastatic colorectal cancer(mCRC)after sequentially receiving both bevacizumab and cetuximab during the course of treatment.Methods:Twenty-six mCRC patients who received both bevacizumab and cetuximab at the Sun Yat-sen University Gastrointestinal Hospital were retrospectively analyzed.Group A(n¼8)comprised patients who received bevacizumab first,and group B(n¼18)comprised those who received cetuximab first.The objective response rate,progression-free survival,and overall survival were compared.Results:Baseline characteristics between the two groups were statistically similar.The objective response in groups A and B patients was 62.5%and 66.6%,respectively(P¼0.132).The median progression-free survival for groups A and B patients was 13 and 10 months,respectively(P¼0.798).The median overall survival for the entire cohort was 42 months,44 months for group A and 39 months for group p B(P¼0.862)patients,respectively.Patients aged<40 years had worse survival than those aged40 years(22 vs 44 months;P¼0.029).Patients with synchronous metastasis had worse survival than those with metachronous metastasis(unreached and 36 months,respectively).In multivariate analyses,synchronous metastasis and age remained statistically significant.The hazard ratio for synchronous metastasis was 4.548,and the HR for patients aged40 years was 0.237.Conclusion:A longer median survival time was observed in patients regardless of the targeted therapy sequence,which warrants further investigation.