| Objective:Mastastic colorectal cancer is frequent in tumors of the gastrointestinal tract.Haplo-chemotherphy in treating metastatic colorectal cancer was limited. Cetuximab is an IgG1 chimeric monoclonal antibody, which can combine the extracellular domain of epidermal growth factor receptor (EGFR) with high specificity and affinity, to blocks acceptor's phosphorylation and dimeride to form. Cetuximab inhibits cell proliferation,promotes apoptosis,decrease matrix metalloproteinases and vascular endothe- lial growth factor, and to bring into full play anticancer. Recent studies have demonstrated that cetuximab is active in metastatic colorectal cancer combi- ned with cytotoxic drug, no matter in the first or secord,third-line treatment. Cetuximab can improve overall response rae and median time to progress, inversion cytotoxic drug resistance and prove quality-of-life measures, impr- ove overall survival. Therefore researcher evaluate the efficacy, time to prog- ression and toxicities cetuximab combined with FOLFOX4 and FOLFIRI che- motherapy regimens in metastastic colorectal cancer.Methods:26 patients with pathologically confirmed mastastic colorectal cancer were enrolled in 1st Affiliated Hospital of Dalian Mdeical University from Oct 2006 to Dec 2008. Cetuximab combined with standard 16 FOLFOX4 chemotherapy and 10 FOLFIRI chemotherapy were in cluded. Cetuximab init- ial dose 400mg/m2 ivgtt during week 1, then 250mg/m2 ivgtt weekly, on day 1; Oxaliplatin 85mg/m2 ivgtt, on day 1,one cycle was consisted of two weeks; irinotecan 180mg/m2 ivgtt, on day 1,one cycle was consisted of two weeks; leucovorin 200mg/m2 ivgtt, on days 1 and 2, followed by fluorouracil 400mg/m2 bolus then 600mg/m2 intravenous infusion during 22 hours on days 1 and 2.One cycle was consisted of two weeks. The efficacy was evaluated according to RECIST (response evaluation criteria in solid tumor),and safety was evaluated according to NCI-CTCAEv3.0(common terminology criteria of adverse events v3.0).Survival analysis was performed using Kaplan-Meier method and log-rank test and P< 0.05 was considered as significant by software of SPSS 14.0.Results: Twenty-six MCRC were evaluated by RECIST criteria with a response rate (RR) of 34.6% and disease control (DC) rate of 65.4%. Subg- roup analysis showed that the response rate (RR) was 80%, DC rate was 100% and for the first-line therapy,23.8% and 57.1% for the second-line therapy. Median time to progress (TTP) were 9 months for the first-line therapy,5 months for the second-line therapy.The main toxicities were rash, nausea, neutropenia, leucopenia.Rash was observed in 69.2% of the patients and the rate of with grade 3 rate was 3.8%.neutropenia occurred in 76.9% of patients, grade 3-4 was observed in 11.5%.Conclusion:1,Cetuximab in combination with FOLFOX4 and FOLFIRI chemothe- rapy in metastastic colorectal cancer can improve overall response rate and median time to progress, improve overall survival, preserve quality-of-life measures.2,Cetuximab in combination with chemotherapy is safe and effective in first,second-line treatment for patients with metastastic colorectal cancer, especially in first-line therapy. The curative effect in grade 2 and grade3 of the shin rash was more super than the grade 0～1.3,All of patients were generally well tolerated.The main adverse events include rash , neutropenia,nausea. The reasearcher advise to take cetuximab combined with chemotherapy as one of schemes for metastastic colorectal cancer. |
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