JCO：西妥昔单抗升级剂量治疗转移性结直肠癌

2012-07-30 卢秀玲医学论坛网

       《临床肿瘤学杂志》（Journal of Clinical Oncology）于2012年7月2日在线发表的一项随机EVEREST研究表明，对于伊立替康-难治性转移性结直肠癌患者，采用西妥昔单抗升级剂量治疗或较标准剂量更有效。　　人们认为，在若干肿瘤类别中，患者服用西妥昔单抗出现的皮肤毒性与临床转归呈正相关。本试验研究了对于伊立替康-难

《临床肿瘤学杂志》（Journal of Clinical Oncology）于2012年7月2日在线发表的一项随机EVEREST研究表明，对于伊立替康-难治性转移性结直肠癌患者，采用西妥昔单抗升级剂量治疗或较标准剂量更有效。

　　人们认为，在若干肿瘤类别中，患者服用西妥昔单抗出现的皮肤毒性与临床转归呈正相关。本试验研究了对于伊立替康-难治性转移性结直肠癌患者，采用西妥昔单抗升级剂量治疗的效果，这些患者经标准剂量西妥昔单抗治疗21天后未发生或发生轻微皮肤反应。该文报道相关临床与药代动力学数据。

　　西妥昔单抗标准剂量（初始剂量400 mg/m(2)，之后每周250 mg/m(2)）加伊立替康治疗21天后，将皮肤反应≤1级的患者随机分配到西妥昔单抗标准剂量（A组）或升级剂量（升至每周500 mg/m(2)；B组）两组中。皮肤反应≥2级的患者继续按标准剂量西妥昔单抗加伊立替康（C组）治疗。

　　意向治疗人群有157人。药代动力学数据反映剂量增加并且在所研究的剂量范围内是可预测的。西妥昔单抗每周高达500 mg/m(2)的剂量可良好耐受，3到4级不良事件在治疗组之间一般也具有可比性。与标准剂量（n = 45）相比，升级剂量（n = 44）与≥2级的皮肤反应增加有关（59% v 38%）。与标准剂量相比，有证据表明升级剂量增加有效率（30% v 16%）和疾病控制率（70% v 58%），但并未显示任何与总体生存率有关的益处。在一项探索性分析中，与标准剂量相比，升级剂量似乎增加携带野生型原癌基因患者的有效率，但对原癌基因变异的肿瘤患者无效。

　　研究显示，西妥昔单抗血清浓度如所预料的那样随着剂量的增加而增加。较高的剂量水平完全耐受。本研究或提示升级剂量组的有效性提高，这为进一步研究提供了依据。

链接;

Van Cutsem E,Tejpar S,Vanbeckevoort D,Peeters M,Humblet Y,Gelderblom H,Vermorken JB,Viret F,Glimelius B,Gallerani E,Hendlisz A,Cats A,Moehler M,Sagaert X,Vlassak S,Schlichting M,Ciardiello F.Intrapatient Cetuximab Dose Escalation in Metastatic Colorectal Cancer According to the Grade of Early Skin Reactions: The Randomized EVEREST Study.J Clin Oncol 2012 Jul 2

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2012-09-11 chengjn

#西妥昔#

28 0
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2012-12-22 lidong40

#JCO#

44 0
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2012-08-01 1249842em09(暂无昵称)

#转移性#

38 0
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2012-08-01 crystal0564

#结直肠#

34 0

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