Chemotherapy and Targeted Therapy in Colorectal Cancer: The Current Status

大腸直腸癌之化學治療及標靶治療之近況

梁偉雄(Wai-Hung Leung) ； 劉建國(Chien-Kuo Liu)

《台灣癌症醫學雜誌》 30卷1期 (2014/03) Pp. 11-20

https://doi.org/10.6323/JoCRP.2014.30.1.2

摘要

在台灣，大腸直腸癌的發生率高居第一位，其死亡率在男與女均為第三位。當大腸直腸癌被診斷時，有四分之三的患者可以手術治療。分子生物及遺傳研究如染色體不穩定、微衛星不穩定及CpG島甲基表現型等均可加強傳統分期對於預後之評估及可更針對性對於個別病患設計使用藥物。大腸直腸癌第三期的患者，術後接受輔助性化學治療可提高存活率，為一標準的治療方法；另維持性化療使用可更增進療效。化療亦可改善高風險之第二期大腸癌的患者的存活率。大腸直腸癌完全切除後輔助性化學治療的目標在於增加存活以及降低癌瘤的復發率。標靶治療可增強化療效果，但只局限於第四期及轉移之患者，然而不合適使用於第三期病人；用時使用兩種標靶藥物其結果則比使用單一標靶藥物效果來得差。化療能增加肝轉移的切除率，而加入標靶治療更能提升此一效果。

關鍵字

大腸直腸癌 ； 化學治療 ； 標靶治療

並列摘要

Colorectal cancer now has the highest rate of incidence and is the third most common cause of cancer death in both men and women in Taiwan. Molecular and genetic studies such as chromosomal instability, microsatellite instability, and CpG island methylator phenotype pathways provide a more patient-specific prognosis, and enable more tailored medical treatments than clinico-pathologic staging alone. Post-operative adjuvant chemotherapy for stage III CRC is well known to improve survival and reduce recurrence, and maintenance chemotherapy has further improved these outcomes. Moreover, chemotherapy is recommended for those ”high risk” stage II patients. Targeted drugs such as anti-EGFR and anti-VEGR have synergized the chemotherapy effects on patients with stage IV disease. However, the use of targeted therapy in stage III disease may be harmful to survival. The ”dual targeted therapy” have resulted in an adverse oncologic outcome over single targeted therapy. Chemotherapies promote an increased resectability rate of liver metastases, and the addition of a targeted therapy further potentiates such an effect. This article revealed the current status of progress where chemotherapy and targeted therapy are used to treat colorectal cancer.

並列關鍵字

colorectal cancer ； chemotherapy ； targeted therapy