Jianhua Zhu, Wei Xu, Wei Tang
Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Suzhou, China.
Summary
Purpose: To explore the clinical efficacy and safety of capecitabine combined with bevacizumab, capecitabine monotherapy, and bevacizumab monotherapy in the maintenance therapy of metastatic colorectal cancer after first-line chemotherapy.
Methods: The clinical data of 147 patients with pathologically confirmed colorectal cancer in stage TXNXM1 were retrospectively analyzed. The patients were firstly treated with 4-6 cycles of standard first-line chemotherapy. After the disease condition was evaluated as remission or stability, capecitabine and/or bevacizumab was used for maintenance therapy. All the patients were treated with drugs until the disease progressed or intolerable adverse drug reactions emerged. The progression-free survival (PFS), overall survival (OS), adverse drug reactions, and quality-of-life scores were compared among the three groups.
Results: The median PFS (mPFS) and mOS of patients in the combined treatment group, capecitabine group and bevacizumab group were 7.5 months and 25.8 months, 4.9 months and 24.4 months, and 5.7 months and 25.1 months, respectively. The results of log-rank test revealed that the PFS of the combined treatment group was significantly longer than in the capecitabine group and bevacizumab group (p=0.043, p=0.046). However, there was no statistically significant difference in the PFS between the capecitabine and bevacizumab group (p=0.889). Besides, no statistically significant difference was observed in the OS among the three groups (p=0.366). The common adverse reactions during treatment mainly included fatigue, nausea and vomiting, diarrhea, hematologic toxicity, impairment of liver and kidney function, hypertension, bleeding, sensory neuropathy, mucositis, and hand-foot syndrome. The combined treatment and the capecitabine group had a higher incidence rate of hand-foot syndrome than bevacizumab group (p=0.007), and the incidence rate of bleeding was higher in the combined treatment and the bevacizumab group than that in the capecitabine group (p=0.027). No statistically significant differences were found in the incidence rates of other adverse reactions (p>0.05). In addition, there were no statistically significant differences in the quality-of-life scores (assessed using the EORTC-QLQ-C30 scale) among the three groups (p>0.05).
Conclusions: Capecitabine combined with bevacizumab is safe and effective in the maintenance therapy of metastatic colorectal cancer, and can significantly prolong the PFS. The drugs are well tolerated, and the patients’ quality of life is not affected.
Key words: capecitabine, bevacizumab, colorectal cancer, maintenance therapy.
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