目的 觀察貝伐珠單抗聯(lián)合伊立替康與雷替曲塞方案在氟尿嘧啶類藥物耐藥后的晚期結(jié)直腸癌患者中的療效及安全性。方法 收集中國醫(yī)科大學(xué)附屬第一醫(yī)院2014—2019年收治的氟尿嘧啶類耐藥的60例晚期結(jié)直腸癌患者，對照組30例，應(yīng)用伊立替康聯(lián)合雷替曲塞方案（IR）；實(shí)驗(yàn)組30例，應(yīng)用IR聯(lián)合貝伐珠單抗方案。分析比較兩組患者的客觀有效率（ORR）、疾病控制率（DCR）、無進(jìn)展生存時(shí)間（PFS）及不良反應(yīng)發(fā)生情況。結(jié)果 實(shí)驗(yàn)組和對照組ORR分別為6.67%和3.33%，DCR分別為66.67%和53.33%，兩組ORR和DCR比較差異無統(tǒng)計(jì)學(xué)意義。實(shí)驗(yàn)組和對照組中位PFS分別為6.0個(gè)月和3.1個(gè)月，差異有統(tǒng)計(jì)學(xué)意義（P=0.020 4）。兩組不良反應(yīng)以Ⅰ/Ⅱ級多見，Ⅲ/Ⅳ級不良反應(yīng)發(fā)生率低，實(shí)驗(yàn)組蛋白尿的發(fā)生率高于對照組，差異有統(tǒng)計(jì)學(xué)意義（P=0.001）。其余如出血、轉(zhuǎn)氨酶升高、惡心、嘔吐、腹瀉、發(fā)熱、皮疹、高血壓等不良反應(yīng)發(fā)生率均為實(shí)驗(yàn)組高于對照組，但差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 貝伐珠單抗聯(lián)合伊立替康與雷替曲塞方案可提高既往氟尿嘧啶類治療耐藥后的晚期結(jié)直腸癌患者的療效，無進(jìn)展生存期增加，不良反應(yīng)可耐受，值得進(jìn)一步研究。

Objective To compare the efficacy and safety of the combination of irinotecan/raltitrexed with bevacizumab in patients with fluorouracil-refractory advanced colorectal cancer. Methods A total of 60 patients with colorectal cancer who failed treatment of fluorouracil chemotherapy and admitted to the First Affiliated Hospital of China Medical University from 2014 to 2019 were selected for further study. 30 patients in control group received IR regimen and 30 patients in experimental group received bevacizumab and IR regimen. Objective response rate (ORR), disease control rate (DCR), progress free surviral (PFS) and adverse reactions between the two groups were evaluated. Results The results demonstrated that the ORR of experimental and control group were 6.7% and 3.3% respectively, DCR of the two groups were 66.7% and 53.33% respectively. There was no significant difference in ORR and DCR between experimental and control group. The median PFS of the two groups were 6.0 months and 3.1 months respectively (P=0.020 4), and the difference was statistically significant. Most of the adverse reactions were grade Ⅰ/Ⅱ. The incidence of grade Ⅲ/Ⅳ adverse reactions was low. The incidence of proteinuria in the experimental group was higher than that in the control group, and the difference was statistically significant (P=0.001). The adverse reactions of bleeding, transaminase elevation (ALT and AST), nausea, vomiting, diarrhea, fever, rash and hypertension were higher in the experimental group with no statistically significant difference. Conclusion The combination of bevacizumab with irinotecan/raltitrexed has certain curative effect in patients with advanced colorectal cancer after treatment failure of fluorouracil. The PFS was increased and the adverse reactions were tolerated, which is worthy of further clinical study.

R979.1