What is the Optimal Cytotoxic Regimen for Advanced Colorectal Cancer?

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Hong Kong J Radiol 2011;14(Suppl):S31-6

It is now well recognised that patients with metastatic colorectal cancer represent heterogeneous subgroups of patients with differing prognoses, because of differences in the number and sites of metastases, performance status, and the types of prior treatment. In fit patients with liver-only metastases in whom local ablative therapies may be rendered possible following downstaging of the metastases, multidrug systemic therapies achieving high tumour shrinkage rates may be the optimal choice. In contrast, patients with multiple sites of extrahepatic metastases or whose performance status is impaired, sequential single or two-drug regimens may be the more appropriate palliative approach, with the aim of extending progression-free survival. Recent studies have revealed that certain combinations of systemic therapies may result in overlapping toxicities or even worse clinical outcomes. A meta-analysis has also suggested that certain targeted therapies (monoclonal antibodies) may yield better clinical outcomes when combined with specific cytotoxic agents. Other special patient subgroups such as the elderly or those with impaired organ function deserve special consideration when selecting systemic therapies. This review summarises current data regarding optimal systemic therapy for different subgroups of patients with metastatic colorectal cancer.





隨著分子標靶療法的發展,加上對表皮生長因子受體﹣酪胺酸酶抑制劑(EGFR-TKI)及血管新生抑 制劑兩種藥物的認可,治療晚期非小細胞肺癌的方案不斷演進。研究顯示表皮生長因子受體的突變 可預測對EGFR-TKI療法的療效。對於受體突變呈陽性的晚期非小細胞肺癌患者,最近的第三期研 究結果確定了EGFR-TKI作為第一線治療 (結合erlotinib或gefitinib),比傳統化療法更為有效。值得注 意的是,當用作第一線藥物時,erlotinib是唯一一個EGFR-TKI可延長患者的無惡化生存期超過12個 月。此外,一項第二期研究(CTONG0803)的結果亦顯示erlotinib單一療法可有效醫治帶有無症狀腦轉移癌的表皮生長因子受體突變呈陽性的非小細胞肺癌患者。另兩項研究的亞群組分析中,確認了 以bevacizumab為基礎的化療對於非鱗狀非小細胞肺癌患者的效用及安全性,確定了bevacizumab醫治 非鱗狀非小細胞肺癌患者的好處。另一項第三期研究(AVAPERL)結果顯示對於一線bevacizumab導 引治療有反應的晚期非小細胞肺癌患者,結合bevacizumab及pemetrexed的持續性維持治療可以延長 其存活期。