The Clinical Observation Of Targeted Drugs In First-line Treatment Of Right-and Left-sided Colon Cancers

Objective:To evaluate the efficacy and toxicities of targeted therapy in metastatic Right-and left-sided colon cancers and evaluate the objective response rate,disease control rate,the median progression-free survival,and analyze the associations of different targeted drugs,chemotherapy regimens,single / multi-organ metastasis,age between chemotherapy alone group and targeted therapy group,as well as myelosuppression,gastrointestinal reaction,rash,hypertension and other adverse reactions.Methods: A total of 119 patients with metastatic colon cancer treated with at the First Affiliated Hospital of Dalian Medical from October 2010 to October 2015 were included.Among this,there were 61 patients treated with targeted drugs combined with chemotherapy(including cetuximab group 34 cases and Bevacizumab group 27 cases)and 58 patients were in pure chemotherapy group.The response to treatment was evaluated according to RECIST 1.1 criteria,treatment-related adverse events were evaluated with CTCEA 4.0.Objective response rate(ORR),disease control rate(DCR),median progression-free survival(PFS)were analyzed respectively.To evaluate the efficacy of chemotherapy alone group and targeted therapy group targeted drugs in metastatic Right-and left-sided colon cancers.Subgroup analyses were performed to research the impact of the targeted drugs,chemotherapy regimens,the number of metastases,age.Statistical analyses were carried out using Kaplan-Meier curve,log-rank test and COX regression analysis.Results:1.(1)The ORR of targeted therapy group and chemotherapy alone group in the first-line treatment of left-sided colon cancers was 11.8% and 37.10%,DCR was 85.30 and91.40%,median PFS was 7.065 months and 9.517 months.Except DCR,ORR and median PFS are improved.(2)But ORR,DCR,median PFS were of no statistical significance in Right-sided colon cancers.2.(1)Compared with chemotherapy alone group,Cetuximab group increased ORR(50.00% vs 11.80%)and prolonged median PFS(8.144 months vs 5.276 months),but not increased DCR in left-sided colon cancers.This effect did not appear in Bevacizumab group.(2)Comparing chemotherapy group,Bevacizumab group increased DCR(100.00% vs 70.80%)and prolonged median PFS(14.236 months vs 7.904months),but not increased DCR in right-sided colon cancers.This effect did not appear in Cetuximab group.3.(1)To contrast targeted treatment group and chemotherapy alone group which based oxaliplatin chemotherapy regimen in the first-line treatment of left-sided colon cancers,the differences of ORR(50.00% vs 12.50%)and PFS(8.501 months vs 5.641months)were not statistcally significant,but not in DCR.However,the treatment of based Irinotecan chemotherapy regimen,both the group showed the improvement in ORR,DCR and PFS.(2)There were not statistically significant in ORR,DCR and median PFS in both based chemotherapy regimen in Right-sided colon cancers.4.(1)Comparing chemotherapy group,targeted treatment group increased ORR(53.30%vs 18.19%),but cant't improved DCR and median PFS in the patients with single organ metastasis in left-sided colon cancers.But in the patients with multiple organ metastasis,ORR,DCR and median PFS were not improved.(2)ORR,DCR,PFS were of no statistical significance in all Right-sided colon cancers.5.(1)Compared with chemotherapy alone group,targeted treatment group increased ORR(54.55% vs 7.14%),but cant't improved DCR and median PFS in patients 65 years and older in left-sided colon cancers.But patients with less than 65 years old,ORR,DCR and median PFS showde no significant difference.(2)ORR,DCR,PFS were of no statistical significance of all ages in Right-sided colon cancers.6.BMI,Baseline CEA values,haemoglobin levels all influenced median PFS in left-sided colon cancers.Both Baseline CA199 values and haemoglobin levels affected median PFS in right-sided colon cancers.7.Compare with chemotherapy alone group the adverse reactions of Bone marrow suppression,gastrointestinal toxicity,liver damage and neurological toxicity were not statistcally significant in targeted treatment group.Cetuximab group had significantly higher incidence of rash and hand-foot syndrome,but tolerance with these adverse reactions well.Bevacizumab group had significantly higher incidence of hypertension and proteinuria,but tolerance with these adverse reactions well.Conclusion:1.Compared with chemotherapy alone group,targeted therapy group could improve short-term effect in the first-line treatment of left-sided colon cancers.But there were no statistical significance in Right-sided colon cancers.2.Comparing chemotherapy group,short-term effect was improved in Cetuximab group in left-sided colon cancers.However,Bevacizumab group couldn't improved in right-sided colon cancers.3.To contrast targeted treatment group and chemotherapy alone group which based oxaliplatin chemotherapy regimen in the first-line treatment of left-sided colon cancers,short-term effect was improved.But there were not improved in both based chemotherapy regimen in Right-sided colon cancers.4.Compared with chemotherapy alone group,targeted treatment group Organ metastasis and age cant't improved both in left-sided colon cancers and right-sided colon cancers.5.BMI,Baseline CEA values,haemoglobin levels could become a predictor of targeted treatment of median PFS in the first-line treatment in left-sided Colon Cancer.However,Baseline CA199 values and haemoglobin levels could become a predictor of targeted treatment of median PFS in the first-line treatment in right-sided ColonCancer.6.The main side effects were similar between chemotherapy alone group,and targeted therapy group.