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Comparison of Efficacy of Panitumumab in Combination with Oxaliplatin-based versus Irinotecan-based Chemotherapy

Panitumumab合併Oxaliplatin類及Irinotecan類化療藥物之療效比較

摘要


Purpose. Patients with metastatic colorectal cancer (mCRC) are faced with poor prognosis. It is well-established that the addition of panitumumab (Pmab) to conventional chemotherapy is able to achieve survival benefit in such patients. However, the comparison of efficacy of Pmab with oxaliplatin-based chemotherapy agent (Pmab-OX) and Pmab with irinotecan-based chemotherapy agent (Pmab-IRI), in a real-world situation required further investigations. Methods. The study collected cases of Rat sarcoma viral oncogene homologue (RAS) wild-type (WT) mCRC receiving first-line treatment with either Pmab-OX or Pmab-IRI in E-Da Hospital and E-DA Cancer Hospital between 2017 and 2021. The primary end-point measured was the objective response rate (ORR). Secondary end points included progression-free survival (PFS), overall survival (OS), and colorectal liver metastasis (CRLM) resection rate. Results. 21 patients with wild-type RAS (WT-RAS) mCRC receiving first-line Pmab with conventional chemotherapy were recruited. The ORR was 33% in both Pmab-OX and Pmab-IRI groups. Mean PFS of Pmab-OX and Pmab-IRI were 29 months and 30 months, respectively. Mean OS of Pmab-OX and Pmab-IRI were 34 months and 30 months, respectively. The liver resection rate in the CRLM-only patients after panitumumab treatment was 43%. Conclusions. In the WT-RAS mCRC patients, first-line Pmab-OX and Pmab-IRI showed similar efficacy, where no statistically differences in ORR, PFS, and OS were observed. However, due to the small sample size and the follow-up time being less than 5 years in all the cases, further studies will be needed to determine the efficacy of Pmab-OX and Pmab-IRI.

並列摘要


目的:大腸癌診斷時已經轉移之案例其預後非常差,雖然已證實全身性化療能有效延長存活,但預後還是不好。近年來許多國家開始在治療上搭配標靶藥物使用,同時使用panitumumab(Pmab)已被證實可有效增加存活率,本研究在轉移性wild-type RAS大腸癌之患者上使用Pmab,並合併含 oxaliplatin(OX)或irinotecan(IRI)之化療藥物,在兩者的使用經驗上來做比較。研究方法:研究收集2017~2021年間義大醫院及義大癌治療醫院轉移性WT-RAS大腸癌之患者,在第一線含oxaliplatin或irinotecan之化療藥物中加入Pmab治療上做比較。主要療效指標為客觀緩解率(objective responserate, ORR)。次要療效指標包括無惡化存活期(progression-freesurvival, PFS)、整體存活率(overall survival, OS)、和肝轉移切除率(liver metastases resection rate)。結果:此研究共收集21名患者。兩者化療藥物加Pmab的ORR同樣為33%,Pmab-OX及Pmab-IRI之疾病無惡化存活期分別為29個月及30個月;而總生存率為34個月及30個月。在單獨肝轉移之病人上使用Pmab後的肝切除率為43%。結論:在WT-RAS mCRC患者上,在無論所選為含oxaliplatin或irinotecan之化療藥物中,加入Pmab都顯著的改善ORR,Pmab-OX及Pmab-IRI的比較下,ORR、PFS及OS都沒有顯著的差異。然而,由於樣本量小和追蹤時間都少於5年,尚無法定論長期下來之結果是否會有差異,未來更長期的追蹤研究是必是需要的。

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