Clinical Efficacy Of First-line Treatment Of Chemotherapy Plus Cetuximab And Chemotherapy For Stage ? CRC

Objective:About 25% of colorectal cancer patients are diagnosed stage ? CRC firstly.About 50%-60% patients are diagnosed stage ? CRC with the progress of the disease.Chemotherapy,targeted therapy and support therapy are effective clinical strategies for them nowadays.The purpose of this study was to analyzes the efficacy and safety of first line treatment of chemotherapy plus cetuximab and chemotherapy for stage ? CRC,the Clinical efficacy of cetuximab in the left and right ? CRC,analyzes the correlation of the influence factors,to provide reference basis of individualized treatment and prognosis for patients with stage ? colorectal cancer in Dalian,Liaoning province.Methods:Patients with stage ? CRC treated with at the First Affiliated Hospital of Dalian Medical University from Jan.1st 2011 to Jan.1st 2016 were included.These patients had pathology or radiographic evidence which proved to be stage ? CRC,included metastatic stage ? CRC firstly and recurrence or metastatic after surgery radical operation.All patients were accepted for more than 2 cycles and first-line treatment included chemotherapy plus cetuximab and chemotherapy.The response to treatment Was evaluated according to RECIST 1.1.Recent curative effect included objective response rate(ORR)and disease control rate(DCR).Long-term curative effect included progression free survival(PFS)and overall survival(OS).Treatment-related adverse events were evaluated with CTCEA 4.0.They were divided into chemotherapy plus cetuximab and chemotherapy;Depending on the primary tumor location,they were divided into left half colon cancer(LCC)group and right half colon cancer(RCC)group,and rectal cancer was divided into left colon cancer.A total of 156 patients were collected,of which the LCC was 71 cases and RCC was 23 cases in chemotherapy group,the LCC was 48 cases and RCC was 14 cases in chemotherapy plus cetuximab group.The follow-up was done by looking up the medical records and placing calls,the end time was Jan.1st 2018.Statisticalanalysis was performed by SPSS 22.0,Chi-square test,Kaplan-Meier curve,COX regression analysis,P <0.05 have statistical significance.Results:1.Recent curative effect:The ORR of chemo-cetuximab group and chemo group were29.0%and 13.8%respectiVely,which was statistically significant(P =0.023).DCR were72.6%and 60.6% respectively,no statistically significant difference(P = 0.135).In LCC group,the ORR were 29.2% and 12.6%,which was statistically significant(P =0.025);the DCR were 72.9% and 59.1%,no statistically significant difference(P =0.123).The ORR of RCC were 28.5% and 17.4%,no statistically significant difference(P = 0.517),the DCR were 71.4% and 65.2%,no statistically significant difference(P =0.760).2.PFS: The median PFS of Chemo-cetuximab group and chemo group were 9.6 months and 7.2 months respectively,which was statistically significant(P = 0.016).In LCC,PFS were 10.3 months and 7.7 months respectively,which was statistically significant(P =0.036).The PFS of RCC were 6.8 months and 6.1 months respectively,no statistically significant difference(P = 0.494).The PFS of LCC and RCC in Chemo-cetuximab group were 10.3 months and 6.8 months respectively,and the difference has no statistical significance(P = 0.537).3.OS:The median OS of Chemo-cetuximab group and chemo group were 25.5 months and 18.2 months respectively,which was statistically significant(P = 0.019).In LCC,OS were 25.8 months and 19.0 months respectively,which was statistically significant(P =0.010).The OS of RCC were 13.6 months and 14.4 months respectively,no statistically significant difference(P = 0.797).The OS of LCC and RCC in Chemo-cetuximab group were 25.8 months and 13.6 months respectively,which was statistical significance(P =0.015).4.The ECOG score and CEA values Before first treatment influence the PFS and OS of Chemo-cetuximab group.The PFS and OS of ECOG score=2 and ?1 have statistical significance(P =0.043 and 0.015).The PFS and OS of CEA ?10 ng/ml and < 10 ng/ml have statistical significance(P =0.024 and 0.033).Some other factors,such as gender,age,whether it transfered firstly,the number of the transfer organs,chemotherapy regimens,were no statistically significant difference.5.The ECOG score affected PFS and OS of patients in chemotherapy group directly,which was statistical significance,P =0.007 and 0.000.the number of the transfer organs affect its OS,which was statistical significance,P = 0.001,and may affect the PFS in some degree,P = 0.056,and age may affect its OS,P = 0.053.6.Compared with the chemotherapy group,Chemo-cetuximab group had significantly higher incidence of rash and hand-foot syndrome,both of which were statistical significance,P < 0.05.Bone marrow suppression,gastrointestinal toxicity,liver damage and neurological toxicity were not statistcally significant.Conelusion:1.The efficacy of Chemo-cetuximab treatment for stage ? colorectal cancer is better than the chemotherapy,especially in the left half colon cancer;2.The ECOG score,CEA values Before first treatment and the number of the transfer organs can be as indicators of prognosis in stage ? CRC;3.Rash and hand-foot syndrome are the side effects of cetuximab,all can be tolerated well by patients.