结直肠癌2015年的进展.ppt

* Bev, bevacizumab; FOLFIRI, irinotecan, 5-fluorouracil, leucovorin; FOLFOXIRI, 5-fluorouracil, leucovorin, oxaliplatin, irinotecan; mCRC, metastatic colorectal cancer; OS, overall survival; PFS, progression-free survival. Results from the TRIBE study, with a median follow-up of 48 months, showed a statistically significant improvement in median OS of approximately 4 months, favoring the triple-drug combination.[4] In my opinion, this is a clinically significant improvement. The PFS was similarly improved, with an HR of 0.77. ? However, it is not clear whether all patients with CRC can tolerate triple-drug therapy, which may be most appropriate for only a subset of patients. This should be the subject of future studies before this regimen becomes the standard of care. For example, if response is an important endpoint for a particular individual who may be having some discomfort or is at risk of having organ function threatened by bulky disease, it would be reasonable to go with the more aggressive therapy first. ? In my practice, when I do choose a triple-drug combination, which is not very often, once a response is achieved, I will taper down to 2 drugs by stopping the most toxic of the 3 agents. This varies depending on the patient, who may have more trouble with irinotecan or oxaliplatin adverse events. * * FOLFIRI, irinotecan, 5-fluorouracil, leucovorin; IV, intravenous; mCRC, metastatic colorectal cancer; ORR, objective response rate; OS, overall survival; PD, progressive disease; PFS, progression free survival.; q2w, every 2 weeks. RAISE is a phase III trial designed to answer an important question: Is there value to ramucirumab as second?line therapy if combined with FOLFIRI in patients with metastatic CRC who fail first?line chemotherapy with an oxaliplatin- and bevacizumab?containing regimen? In this well-designed trial, patients (N = 1050) were randomized to receive either FOLFIRI alone at standard doses or FOLFIRI plus ramucirumab at 8?mg/kg every