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Study on Bevacizumab Plus Chemotherpay on Patients with Advanced Colorectal Cancer

Author: CuiSaiQiong
Tutor: LiuJiWei
School: Dalian Medical University
Course: Oncology
Keywords: Colorectal cancer Bevacizumab Chemotherapy Targeted therapy
CLC: R735.34
Type: Master's thesis
Year: 2013
Downloads: 20
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Abstract


Background and Objective: Colorectal cancer is one of common malignanttumors, The incidence rate accounted for about10%of all malignant tumor,It has beenalso increasing year by year in our country.the main therapy of advanced colorectalcancer includes irinotecan or oxaliplatin based chemotherapy, combind with antiepidermal growth factor receptor(EGFR) and anti vascular endothelial growth factor(VEGF)monoclonal antibody targeted therapy. Bevacizumab is a monoclonalantibody targeting vascular endothelial growth factor(VEGF),combined withchemotherapy can improve efficacy and survival. This study is conducted to analyze theefficacy and toxicity of bevacizumab plus chemotherapy on patients with advancedcolorectal cancer. The purpose is to analysise the current status in treatment and thefactors influencing efficacy of advanced colorectal cancer with bevacizumab pluschemotherapy in Dalian district.Method:29patients used bevacizumab in the treatment of advanced colorectalcancer from oct-2010to feb-2013was collected by the research method ofnon-randomized non-concurrent control retrospectively in Dalian. All cases wereevaluated about efficacy, toxicity and quality of life. And stratified analysis comparisonof different age group, PS score, the degree of tumor differentiation, tumor location, thenumber of metastasis organ, whether liver metastasis, different chemotherapyregimens, the changes of tumor markers, each line treatment, whether acceptmaintenance therapy, the K-ras status and whether the quality of life was improved twogroups have difference in efficacy; multivariate analysis of the factors influencing theprognosis of advanced colorectal cancer treated with bevacizumab plus chemotherapy.Results: All29patients collected have evaluable lesions.14patients acceptedfirst-line therapy,6patients accepted second-line therapy,9patients accepted more than second-line therapy of those,6patients accept maintenance therapy.2patientsdiscontinued because of the adverse events of fever and bleeding respectively. Themean treatment was5.4cycles (1-16). The overall response rate (ORR) was37.9%,,disease control rate (DCR) was89.7%, median progression-free survival (PFS) time6.6month,overall survival (OS)>12.1month. Median PFS of first-line therapy was8.2months, RR was42.9%, DCR was85.7%. Median PFS of second-line therapy was6.5months, RR was0, DCR was100%. Median PFS of more than second-line therapy was6.0month,RR was37.5%, DCR was88.9%. Stratified analysis showed the PFS ofdifferent age group, PS score, tumor location, the number of metastasis organ, whetherliver metastasis, different chemotherapy regimens, the K-ras status had no statisticaldifference between two groups(P>0.05); the different group of tumor differentiation,changes of tumor markers, each line treatment, whether accept maintenance therapy andthe quality of life was improved had statistical difference(P<0.05). The PFS of high-middle differentiation group is favorable in comparison to low differentiation group(P<0.05).The PFS of first-line therapy is favorable in comparison to second-line andmulti-line therapy(P<0.05).PFS between second-line and multi-line therapy had nostatistical difference(P>0.05).PFS of with or without maintenance therapy is8and6.1months respectively, The difference was significant(P<0.05). After the treatment ofbevacizumab plus chemotherapy, the tumor marker decrease group had better DCR(P<0.05) and PFS than does not decrease group, PFS was8and5.8monthsrespectively(P<0.05).The quality of life was improved after the treatment, Scores ofphysiological field, psychological field, social relations field were increased(P<0.05).But there was no significant difference in environmental field(P>0.05).Quality of life improved patients had better PFS than those did not improved,is7.6and5.4months respectively(P<0.05). multivariate analysis showed tumordifferentiation and accept maintenance therapy was not independent prognostic factors(P>0.05). First-line therapy, tumor marker decrease and improved quality of life wasindependent prognostic factors(P<0.05).The incidence rate of adverse events of bevacizumab in combination withchemotherapy was89.7%. The main adverse events included: gastrointestinal side effect(58.6%), bone marrow suppression (51.7%), Bleeding (34.5%), hypertension (24.1%),liver injury (20.7%), proteinuria (13.8%) etc. grade3–4adverse events includedhypertension (10.3%), neutropenia (6.9%), gastrointestinal reaction (10.3%) andbleeding (10.3%). Bevacizumab possibly related adverse events included: bleeding (34.5%), hypertension(24.1%), proteinuria (13.8%), thrombosis(6.9%). grade3–4adverse events included bleeding (34.5%), hypertension(24.1%), thrombosis(6.9%).Conclusions: The treatment of advanced colorectal cancer with bevacizumab pluschemotherapy in Dalian showed efficacy. The PFS of first-line therapy is favorable incomparison to second-line and multi-line therapy. multi-line treatment can also achievegood efficiency and disease control rate. The quality of life was improved after thetreatment. The maintenance treatment with bevacizumab was well tolerated. And PFSwas better than those without maintenance treatment. First-line therapy, tumor markerdecrease and improved quality of life was independent prognostic factors.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Intestinal neoplasms > Colorectal tumors
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