Colorectal cancer is the third most common disease and the second most common cause of death around the world. The drug for second-line treatment depends on the drugs used in first-line treatment and the biomarker status. As biomarkers, theRASgene,BRAFgene, and dMMR/MSI-H, TMB-H, and HER2 statuses have been established in clinical practice, and the corresponding molecularly targeted therapeutic agents are selected based on the biomarker status. Given the frequency of biomarkers, it is assumed that when patients move on to second-line treatment, an angiogenesis inhibitor is selected in many cases. For second-line treatment, three angiogenesis inhibitors, bevacizumab (BEV), ramucirumab (RAM), and aflibercept (AFL), are available, and one of them is combined with cytotoxic agents. These three angiogenesis inhibitors are known to inhibit angiogenesis through different mechanisms of action. Although no useful biomarkers have been established for the selection of angiogenesis inhibitors, previous biomarker studies have suggested that angiogenesis-related factors such as VEGF-A and VEGF-D might be predictors of the therapeutic efficacy of angiogenesis inhibitors. These biomarkers are measured as protein levels in plasma and are considered to be promising biomarkers. We consider that the rationale for selecting among these three angiogenesis inhibitors should be clarified to benefit patients.
结直肠癌是全球第三大常见疾病及第二大死亡原因。二线治疗药物的选择取决于一线用药方案及生物标志物状态。目前临床实践中已确立RAS基因、BRAF基因、dMMR/MSI-H状态、TMB-H状态及HER2状态作为生物标志物，并依据其检测结果选择相应的分子靶向治疗药物。鉴于生物标志物的分布特征，多数患者在进入二线治疗时需选择血管生成抑制剂。现有贝伐珠单抗（BEV）、雷莫芦单抗（RAM）和阿柏西普（AFL）三种血管生成抑制剂可用于二线治疗，需与细胞毒性药物联合使用。这三种血管生成抑制剂通过不同的作用机制抑制血管生成。虽然目前尚未建立用于选择血管生成抑制剂的有效生物标志物，但既往生物标志物研究表明，VEGF-A、VEGF-D等血管生成相关因子可能成为预测血管生成抑制剂疗效的指标。这些生物标志物通过血浆蛋白水平进行检测，被认为具有临床应用潜力。我们主张明确这三种血管生成抑制剂的选择依据，以期为患者提供更精准的治疗方案。
肿瘤(癌症)患者之家