Background/Objectives: Metastatic colorectal cancer (mCRC) is mainly treated with 5-Fluoro-Uracil (5-FU), Oxaliplatin and Irinotecan chemotherapies and anti-Epidermal Growth Factor Receptor (EGFR) or anti-Vascular Endothelial Growth Factor (VEGF) targeted therapies. Due to chemotherapy-related toxicity, patients receive induction treatment to achieve tumour response followed by maintenance therapy with less cytotoxic molecules or a chemotherapy-free interval to reduce chemotherapy-related toxicity. In this study, the aim was to determine the patient, cancer and treatment factors that influence the duration of maintenance therapy (DMT). Methods: We collected retrospective data on a cohort of 133 patients treated at the Centre Georges François Leclerc (CGFL) cancer centre in Dijon between March 2014 and June 2022. Patients had unresectable or potentially resectable diseases. They received first-line induction treatment with chemotherapy and/or targeted therapy and maintenance treatment, defined as the interruption of at least one chemotherapy agent. Results: In the multivariate analysis, age (HR: 1.02, 95% CI 1.00–1.04,p= 0.031), N2 nodal status (HR: 1.78, 95% CI 1.09–2.89,p= 0.021) and the presence of peritoneal metastases (HR: 2.05, 95% CI 1.25–3.36,p= 0.004), as well as baseline carcino-embryonic antigen (CEA) level (HR: 1.10, 95% CI 1.00–1.20,p= 0.052), were significantly associated to poor DMT. Local treatment of liver metastases also significantly reduced the DMT (HR: 0.49, 95% CI 0.28–0.86,p= 0.013). In our cohort, induction triplet chemotherapy significantly increased the CEA delta (70% vs. 44%,p= 0.047) compared to doublet chemotherapy and led to a higher rate of liver surgery (40% vs. 21%,p= 0.014) and a trend for a higher rate of local treatment of metastases (62% vs. 45%,p= 0.059). Conclusions: Duration of maintenance therapy is determined by the initial patient and colorectal cancer characteristics. However, it is significantly increased by local treatment of liver metastases. By reducing the tumour burden, a triplet induction chemotherapy regimen increases the rate of liver metastase resection.
背景/目的：转移性结直肠癌（mCRC）主要采用5-氟尿嘧啶（5-FU）、奥沙利铂和伊立替康化疗联合抗表皮生长因子受体（EGFR）或抗血管内皮生长因子（VEGF）靶向治疗。鉴于化疗相关毒性，患者通常先接受诱导治疗以实现肿瘤应答，随后采用细胞毒性较低的药物进行维持治疗或安排化疗间歇期以减轻毒性。本研究旨在明确影响维持治疗持续时间（DMT）的患者因素、肿瘤特征及治疗参数。方法：我们回顾性收集了2014年3月至2022年6月期间在第戎乔治·弗朗索瓦·勒克莱尔（CGFL）癌症中心接受治疗的133例患者数据。所有患者均为不可切除或潜在可切除病例，均接受了一线化疗和/或靶向诱导治疗及维持治疗（定义为至少停用一种化疗药物）。结果：多变量分析显示，年龄（风险比[HR]：1.02，95%置信区间[CI] 1.00–1.04，p=0.031）、N2淋巴结状态（HR：1.78，95% CI 1.09–2.89，p=0.021）、腹膜转移（HR：2.05，95% CI 1.25–3.36，p=0.004）以及基线癌胚抗原（CEA）水平（HR：1.10，95% CI 1.00–1.20，p=0.052）与较短的维持治疗持续时间显著相关。肝转移局部治疗则显著延长维持治疗时间（HR：0.49，95% CI 0.28–0.86，p=0.013）。在本队列中，与双药化疗相比，三药诱导化疗显著提高了CEA下降率（70% vs. 44%，p=0.047），同时提升了肝转移手术率（40% vs. 21%，p=0.014），并呈现更高的转移灶局部治疗趋势（62% vs. 45%，p=0.059）。结论：维持治疗持续时间取决于患者初始状态及结直肠癌特征，而肝转移局部治疗能显著延长该时间。三药诱导化疗方案通过降低肿瘤负荷，提高了肝转移灶切除率。
Factors Influencing the Duration of Maintenance Therapy in Metastatic Colorectal Cancer
肿瘤(癌症)患者之家