EJC:贝伐珠单抗与胃肠穿孔相关但可控

2012-03-23 MedSci MedSci原创

  一些随机对照研究(RCT)表明,对于接受氟尿嘧啶为基础化疗的转移性结直肠癌患者,加用贝伐珠单抗可延长其总生存期和无进展生存期;但1%~2%的患者会发生胃肠穿孔(GIP)。   美国学者近期在线发表于《欧洲癌症杂志》(European Journal of Cancer)的一项基于社区的大型观察性队列研究表明,GIP发生率与RCT结果一致,但大部分GIP通过手术干预可成功得到控制。   该研

  一些随机对照研究(RCT)表明,对于接受氟尿嘧啶为基础化疗的转移性结直肠癌患者,加用贝伐珠单抗可延长其总生存期和无进展生存期;但1%~2%的患者会发生胃肠穿孔(GIP)。

  美国学者近期在线发表于《欧洲癌症杂志》(European Journal of Cancer)的一项基于社区的大型观察性队列研究表明,GIP发生率与RCT结果一致,但大部分GIP通过手术干预可成功得到控制。

  该研究收集了基线时患者本身和肿瘤特征,包括潜在GIP风险因素。此后每3个月记录1次治疗、不良反应、疾病进展状况和患者生存数据,并收集所有发生GIP事件患者的详细临床数据,采用Cox比例风险回归模型评估基线风险因素对GIP风险的影响。

  结果显示,在中位随访20.1个月且可评估的1953例患者中,37例(1.9%)发生了GIP。

  大部分GIP事件可通过手术处理得以成功控制,4例死亡。

  大部分GIP事件(26例/37例)发生于开始贝伐珠单抗治疗≤6个月(中位值为3.35个月)。

  单变量和多变量分析均显示,年龄≥65岁与GIP风险较低显著相关。

  多变量分析显示,有完整(intact)原发肿瘤和既往接受辅助放疗与开始贝伐珠单抗治疗6个月内GIP风险升高显著相关。

  回归分析显示,GPI风险不随贝伐珠单抗暴露时间延长而累积。

  链接:Gastrointestinal perforation associated with bevacizumab use in metastatic colorectal cancer: Results from a large treatment observational cohort study.

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