전이성 직결장암 환자에서 원발병소 위치에 따른 Cetuximab과 Bevacizumab의 치료효과 비교 분석
Analysis of Therapeutic Effects of Cetuximab and Bevacizumab Related to the Primary Tumor Site in Patients with Metastatic Colorectal Cancer
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background : Recent reports on metastatic colorectal cancer (mCRC) demonstrated that the primary tumor origin site was related to significantly different effects of biologic therapy (BT). However, in the Korean clinical field, patients are still prescribed cetuximab regardless of the primary tumor site. Therefore, it is necessary to determine whether there is a different response to BT in Korean patients as well. This study analyzed the correlation between the effect of BT and the primary tumor origin in patients with mCRC. Methods : This study included all patients diagnosed with mCRC from January 1, 2015, through December 31, 2016, who were treated with first-line chemotherapy containing bevacizumab or cetuximab. We followed the patients using EMR analysis until September 30, 2018. We compared the different effects of BT based on the primary tumor site by the time to progression (TTP) and the overall response rate (ORR). Results : One hundred and sixty-one patients were eligible for the study, 50 patients had right-sided primary tumor origins and 111 patients had tumors on the left. Among patients who received bevacizumab, there was no significant difference regardless of the primary tumor site, whereas, in patients treated with cetuximab, left-sided mCRC was related to longer TTP compared to right-sided (hazard ratio [HR]=1.92, 95% CI: 0.98 – 3.60; p=0.050). In other words, there was no significant difference between bevacizumab and cetuximab in the left-sided mCRC patients. However, in the right-sided mCRC patients, bevacizumab showed a significantly improved TTP compared to cetuximab (HR=2.08, 95% CI: 1.03 – 4.03; p=0.036). Conclusion : The primary tumor site was related to the response to BT in patients with mCRC. Right-sided primary tumor origin was associated with significantly improved TTP when treated with bevacizumab compared to cetuximab. Therefore, we recommend considering not only the molecular status but the primary tumor site when choosing BT for mCRC patients in the future.
Abstract
Background : Recent reports on metastatic colorectal cancer (mCRC) demonstrated that the primary tumor origin site was related to significantly different effects of biologic therapy (BT). However, in the Korean clinical field, patients are still prescribed cetuximab regardless of the primary tumor site. Therefore, it is necessary to determine whether there is a different response to BT in Korean patients as well. This study analyzed the correlation between the effect of BT and the primary tumor origin in patients with mCRC. Methods : This study included all patients diagnosed with mCRC from January 1, 2015, through December 31, 2016, who were treated with first-line chemotherapy containing bevacizumab or cetuximab. We followed the patients using EMR analysis until September 30, 2018. We compared the different effects of BT based on the primary tumor site by the time to progression (TTP) and the overall response rate (ORR). Results : One hundred and sixty-one patients were eligible for the study, 50 patients had right-sided primary tumor origins and 111 patients had tumors on the left. Among patients who received bevacizumab, there was no significant difference regardless of the primary tumor site, whereas, in patients treated with cetuximab, left-sided mCRC was related to longer TTP compared to right-sided (hazard ratio [HR]=1.92, 95% CI: 0.98 – 3.60; p=0.050). In other words, there was no significant difference between bevacizumab and cetuximab in the left-sided mCRC patients. However, in the right-sided mCRC patients, bevacizumab showed a significantly improved TTP compared to cetuximab (HR=2.08, 95% CI: 1.03 – 4.03; p=0.036). Conclusion : The primary tumor site was related to the response to BT in patients with mCRC. Right-sided primary tumor origin was associated with significantly improved TTP when treated with bevacizumab compared to cetuximab. Therefore, we recommend considering not only the molecular status but the primary tumor site when choosing BT for mCRC patients in the future.
참고문헌 (16)
- Alfonso PG, "Prognostic and predictive factors in metastasic colorectal cancer", J Clin Oncol, 36(4), pp.690~ (2018)
- Fotios L, "Primary tumor location as a prognostic factor in metastatic colorectal cancer", JNCI, 107(3), pp.dju427~ (2015)
- Price TJ, "Does the primary site of colorectal cancer impact outcomes for patients with metastatic disease", Cancer, 121(6), pp.830~835 (2015)
- Stintzing S, "Understanding the role of primary tumor localisation in colorectal cancer treatment and outcomes", Eur J Cancer, 84, pp.60~80 (2017)
- Tran B, "Impact of BRAF mutation and microsatellite instability on the pattern of metastatic spread and prognosis in metastatic colorectal cancer", Cancer, 117(20), pp.4623~4632 (2011)
- Missiaglia E, "Distal and proximal colon cancers differ in terms of molecular, pathological, and clinical features", Ann Oncol, 25(10), pp.1995~2001 (2014)
- Tejpar S, "Prognostic and predictive relevance of primary tumor location in patients with RAS wild-type metastatic colorectal cancer retrospective analyses of the CRYSTAL and FIRE-3 trials", JAMA Oncol, 3(2), pp.194~201 (2017)
- Aljehani MA, "Association of primary tumor site with mortality in patients receiving bevacizumab and cetuximab for metastatic colorectal cancer", JAMA Surg, 153(1), pp.60~67 (2018)
- Moretto R, "Location of primary tumor and benefit from anti-epidermal growth factor receptor monoclonal antibodies in patients with RAS and BRAF wild-type metastatic colorectal cancer", Oncologist, 21(8), pp.988~994 (2016)
- Venook AP, "Impact of primary(1o)tumor location on overall survival(OS)and progression-free survival(PFS)in patients(pts)with metastatic colorectal cancer(mCRC) : analysis of CALGB", SWOG 80405(Alliance), 2016, pp.34(15), 3504~
- Wong HL, "Impact of primary tumor site on bevacizumab efficacy in metastatic colorectal cancer", Clin Colorectal Cancer, 15(2), pp.9~15 (2016)
- Boisen MK, "Primary tumor location and bevacizumab effectiveness in patients with metastatic colorectal cancer", Ann Oncol, 24(10), pp.2554~2559 (2013)
- Nitsche U, "Right sided colon cancer as a distinct histopathological subtype with reduced prognosis", Dig Surg, 33(2), pp.157~163 (2016)
- Sinicrope FA, "Analysis of molecular markers by anatomic tumor site in stage Ⅲ colon carcinomas from adjuvant chemotherapy trial NCCTG N0147(alliance)", Clin Cancer Res, 21(23), pp.5294~5304 (2015)
- Missiaglia E, "Distal and proximal colon cancers differ in terms of molecular, pathological, and clinical features", Ann Oncol, 25(10), pp.1995~2001 (2014)
- Mouradov D, "Colorectal cancer cell lines are representive models of the main molecular subtypes of primary cancer", Cancer Res, 74(12), pp.3238~3247 (2014)