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題名 | 轉移性大腸直腸癌的藥物治療策略=Drug Treatment Strategies for Metastatic Colorectal Cancer |
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作者 | 鄭吉元; 蔡慈貞; | 書刊名 | 藥學雜誌 |
卷期 | 34:1=134 2018.03[民107.03] |
頁次 | 頁27-32 |
分類號 | 418.31 |
關鍵詞 | 轉移性大腸直腸癌; 標靶治療; 藥物治療策略; Metastatic colorectal cancer; Cetuximab; Bevacizumab; |
語文 | 中文(Chinese) |
中文摘要 | 轉移性大腸直腸癌 (mCRC) 的藥物治療原則為:一、RAS 原生型第一線可單用化 療,或是化療併用 EGFR 抑制劑 [常用 cetuximab (CET)],或是化療併用 bevacizumab (BV);第二線則單用不同於第一線的化療藥品,或是化療併用 BV,或是 FOLFIRI EGFR 抑制劑無效,因此第一線只能單用化療,或是化療併用 BV。 第一線使用 BV,無論併用 FOLFIRI 或 FOLFOX,兩組之無惡化存活期和整體存 活期皆無統計學上顯著差異,在台灣幾乎都是併用 FOLFIRI,其原因主要是因為受限 於健保給付的規定。RAS 原生型第一線標靶藥物要選擇 BV 或 CET 仍有爭議,臨床 上傾向以 BV 作為第一線治療,而將 CET 列為第三線治療。對於原發於右側大腸的 mCRC 患者不應併用 CET,因為沒有任何額外效益。未來加入免疫治療單獨使用或是 合併其他藥物將使得 mCRC 的治療更加多元化。 |
英文摘要 | The principles of drug treatment for metastatic colorectal cancer (mCRC) are: (1) RAS wild type: first-line with chemotherapy +/- EGFR inhibitor [cetuximab (CET) often used] or chemotherapy +/- bevacizumab (BV), second-line with chemotherapy (unlike first-line) +/- BV or FOLFIRI + aflibercept (or ramucirumab), third-line with regorafenib; (2) RAS mutant type: EGFR inhibitor is ineffective, hence, first-line only with chemotherapy +/- BV. Fist-line treatment with BV plus FOLFIFI was not statistically significant difference compared with BV plus FOLFOX in terms of progression-free survival and overall survival for mCRC patients, in Taiwan FOLFIRI combination is preferred due to reimbursement limitation. Targeted agents of BV or CET, which one should be as the first-line choice for RAS wild type subjects is still controversial, although BV as first-line and CET as thirdline are favored in clinical. mCRC arising in the right-sided colon should not add CET because there was no any additional benefit. In the future, cancer immunotherapy alone or in combination with other drugs will diversify mCRC treatment. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。