Ersin Özaslan, Oktay BOZKURT, Ayşe Ocak Duran, Mevlude İnanç, Metin Özkan

Metastatik kolorektal kanser hastalarında 3. basamak tedavi seçeneği: rechallenge kemoterapi

Amaç: Metastatik kolorektal kanser (mCRC) sağkalımı nedeniyle irinotekan ve oksaliplatin esaslı rejim sonrasında üçüncü basamak tedavide şu an etkili bir seçenek mevcut. Seçici hastalarda tekrarlayan bir kemoterapi rejimi (yeniden sorgulama terapisi) bir seçenek olabilir. Hastalar ve Yöntemler: Hastalar, irinotekan veya oksaliplatin rejimi ile birinci basamakta elde edilenlerle aynı tedavi olan üçüncü basamak tedavisi ile tekrar değerlendirildi. Katı tümörlerde yanıt değerlendirme kriterleri (RECIST) geriye dönük olarak tümör cevabı ve Kaplan Meier yöntemini hesaplayıp sağkalımı hesapladı. Bulgular: Kırk beş hasta bu çalışma için uygun bulunmuştur. Ortanca takip süresi 29 ay idi. Otuz üç hasta (% 73) takip sırasında kaybedildi. Yeniden direnç tedavilerinin 23'ünde (% 51) irinotekan ve 22 (% 49) oksaliplatin rejimi uygulandı. Çoğu hastada iyi performans durumu 0 veya 1, K-RAS yabani tip 31 hastada (% 69) tespit edildi. Genel toksisite, çoğunlukla grade 1 ve 2 olan hematolojik ve gastrointestinal idi. Yanıt oranı% 8.9 iken, 25 hastada (% 55.5) stabil hastalığa sahipti. Klinik fayda oranı% 64.4 olarak hesaplandı. Ortanca progresyonsuz sağkalım (PFS) 6 ay (% 95 CI: 4.68-9.55 ay) ve medyan genel sağkalım (OS) 10 ay olarak bulundu (% 95 CI: 7.00-12.99 ay). Sonuçlar: Bu çalışmanın sonuçları, yeniden seçilme tedavisinin seçilen hastalar için üçüncü basamak tedavisi olarak doğru seçim olabileceğini göstermektedir.

Anahtar Kelimeler:

metastatic colorectal carcinoma, rechallenge chemotherapy, third line, salvage

Rechallenge chemotherapy as a third line treatment option for metastatic colorectal carcinoma

Objective: Currently, there is required effective option in third line therapy after irinotecan and oxaliplatin based regimen because of survival of metastatic colorectal carcinoma (mCRC) increase. A repeated chemotherapy regimen (rechallenge therapy) may be an option in selective patients.Patients and Methods: Patients were rechallenged with irinotecan or oxaliplatin regimen as a third line therapy which was the same therapy that they received as the first line. Response Evaluation Criteria in Solid Tumors (RECIST) was used to retrospectively calculate tumor response and Kaplan Meier method to calculate survival.Results: Forty-five patients were found to be eligible for this study. The median follow up duration was 29 months. Thirty-three patients (73%) had been lost during follow up. Of the rechallenge treatments, 23 (51%) patients were administered irinotecan and 22 (49%) oxaliplatin based regimens. Most patients had a good performans status as 0 or 1 and K-RAS wild-type was detected in 31 (69%) of the patients. The common toxicities were haematologic and gastrointestinal, mostly grade 1 and 2. Response rate was 8.9%, while 25 (55.5%) of the patients had stable disease. Clinical benefit rate was calculated as 64.4%. The median progression-free survival (PFS) as 6 months (95% CI: 4.68–9.55 months) and the median overall survival (OS) was found as 10 months (95% CI: 7.00–12.99 months).Conclusions: The results of this study indicate that rechallenge treatment may be a right choice as a third line therapy for selected patients.

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