J Clin Oncol:氟尿嘧啶/亚叶酸联合帕尼单抗维持治疗可显著延长RAS野生型转移性结直肠癌患者的生存期

2021-09-18 Nebula MedSci原创

氟尿嘧啶/亚叶酸联合帕尼单抗维持治疗或可成为RAS野生型转移性结直肠癌患者诱导治疗后维持治疗的新选择!

既往未治疗过的微卫星稳定的转移性结直肠癌(mCRC)通常采用氟尿嘧啶和亚叶酸(FU/FA)+奥沙利铂(FOLFOX)或(和)伊立替康的联合治疗。此外,这些化疗方案可能还会加用靶向表皮生长因子受体 (EGFR) 或血管内皮生长因子的单克隆抗体。

PANAMA试验是一项随机对照研究,旨在评估在RAS野生型的转移性结直肠癌患者的氟尿嘧啶和亚叶酸维持治疗中加用帕尼单抗(panitumumab,Pmab) 的效果

经6个疗程的FU/FA和奥沙利铂+Pmab一线诱导治疗后,应答者(病情稳定或部分/完全缓解)被随机1:1分至FU/FA+Pamb维持治疗组或FU/FA维持治疗组。主要目的是明确FU/FA+Pamb维持治疗在无进展生存期(PFS,从随机分组到疾病进展或死亡)方面的优越性。次要终点包括总生存期、维持治疗的客观缓解率和毒性反应。

总分析的两组的PFS和OS

总体上,共有248位患者被随机分至FU/FA+Pamb组(n=125)或FU/FA组(n=123)。在截止日期时,FU/FA+Pamb维持治疗的PFS较FU/FA维持治疗的显著延长(8.8 vs 5.7 个月;风险比[HR] 0.72, 95% CI 0.60-0.85, P=0.014)。FU/FA+Pamb组的总生存期在数值上优于FU/FA组,但无显著性差异(28.7 vs 25.7 个月;HR 0.84, 95% CI 0.60-1.18, P=0.32)。FU/FA+Pamb组和FU/FA组的客观缓解率分别是40.8%和26.0%(优势比[OR] 1.96, 95% CI 1.14-3.36, P=0.02)。

部分不良反应事件

在维持治疗期间,最常见的3级及以上的不良事件有皮肤红疹(7.2%)。

综上所述,对于RAS野生型的转移性结直肠癌患者,采用FU/FA联合Pmab维持治疗可诱导获得显著长于FU/FA维持治疗的无进展生存时间。如果患者经FU/FA+奥沙利铂+Pmab诱导治疗后渴望积极维持治疗,FU/FA+Pmab可能是最有利的选择。

原始出处:

Dominik Paul Modest, et al. Panitumumab Plus Fluorouracil and Folinic Acid Versus Fluorouracil and Folinic Acid Alone as Maintenance Therapy in RAS Wild-Type Metastatic Colorectal Cancer: The Randomized PANAMA Trial (AIO KRK 0212). Journal of Clinical Oncology. September 17, 2021. https://ascopubs.org/doi/full/10.1200/JCO.21.01332

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    2022-04-16 minlingfeng
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肝母细胞瘤需采用手术切除,但仅三分之一的新确诊的肝母细胞瘤患者在确诊时,还可进行切除手术。术后通常还需进行4-6个疗程的联合辅助化疗(顺铂、氟尿嘧啶和长春新碱)。对于确诊时已完全切除肝母细胞瘤的患儿,两个疗程的辅助化疗是否足以维持无事件存活?现研究人员对此进行研究。研究人员开展一多中心的3期试验,招募不同风险等级的、采用风险适应性疗法的患者。本次报告是针对低风险患者。受试患者≤21岁、经组织学确诊

JAMA Oncol:VALENTINO研究:帕尼单抗一线维持治疗RAS野生型结直肠癌劣于帕尼单抗联合氟尿嘧啶

2019年7月3日,JAMA Oncology 在线发表VALENTINO研究结果,证明帕尼单抗单药一线维持治疗RAS野生型转移性结直肠癌劣于帕尼单抗联合氟尿嘧啶。

JNCCN:质子泵抑制剂(PPI)可能降低结直肠癌患者的生存

质子泵抑制剂(PPI)是临床上常用的药物。非癌人群观察性研究中发现,长期服用PPI可出现严重的不良后果,比如增加全因死亡率,心血管疾病,肾脏疾病,低镁血症以及肿瘤等。体内实验发现PPI似乎可有增强某些