2025 年第 10 期 第 20 卷

大鼠肉瘤基因野生型转移性结直肠癌一线治疗转换贝伐珠单抗的效果和安全性

The efficacy and safety of switching to bevacizumab in the first-line treatment of metastatic colorectal cancer with wild-type rat sarcoma gene

作者：张瑶李雨琪赵雪汪海岩

英文作者：Zhang Yao Li Yuqi Zhao Xue Wang Haiyan

单位：徐州医科大学附属医院肿瘤内科，徐州221000

英文单位：Department of Oncology the Affiliated Hospital of Xuzhou Medical University Xuzhou 221000 China

关键词：转移性结直肠癌；大鼠肉瘤基因野生型；转换治疗；西妥昔单抗；贝伐珠单抗；皮肤毒性

英文关键词：Metastaticcolorectalcancer;Ratsarcomagenewild-type;Switchtreatment;Cetuximab; Bevacizumab;Skintoxicity

• 摘要：

• 目的 分析一线治疗时不能耐受西妥昔单抗皮肤毒性的大鼠肉瘤(RAS)基因野生型转移性结直肠癌（mCRC）患者转换贝伐珠单抗治疗的效果和安全性。方法 回顾性选取2018年1月至2023年7月于徐州医科大学附属医院接受两药化疗联合西妥昔单抗作为一线治疗并至少完成1次疗效评价且疾病没有进展的RAS野生型mCRC患者143例。观察组为不能耐受西妥昔单抗皮肤毒性而转换含贝伐珠单抗治疗的患者，对照组为能持续性接受含西妥昔单抗治疗的患者，比较2组患者的疗效和安全性。结果 倾向性评分匹配后，观察组和对照组的中位无进展生存期分别为10.5个月（95%置信区间：9.3~11.7个月）和10.8个月（95%置信区间：9.4~12.2个月），组间比较差异无统计学意义（P=0.28）；中位总生存期分别为27.1个月（95%置信区间：22.9~31.3个月）和33.5个月（95%置信区间：25.9~41.0个月），组间比较差异无统计学意义（P=0.17）。治疗期间观察组皮肤毒性比例低于对照组（P＜0.05），2组其他不良反应发生率比较差异均无统计学意义（均P＞0.05）。结论 对于一线治疗期间不能耐受西妥昔单抗皮肤毒性的RAS野生型mCRC患者，转换贝伐珠单抗也是可供选择的一种治疗方案。

• Objective To analyze the efficacy and safety of switching bevacizumab in patients with rat sarcoma (RAS) wild-type metastatic colorectal cancer (mCRC) who could not tolerate the skin toxicity of cetuximab in the first-line treatment. Methods A total of 143 patients with RAS wild-type mCRC who received two-drug chemotherapy combined with cetuximab as first-line treatment and completed at least one efficacy evaluation without disease progression in the Affiliated Hospital of Xuzhou Medical University from January 2018 to July 2023 were retrospectively selected. The observation group was the patients who could not tolerate the skin toxicity of cetuximab and switched to bevacizumab-based treatment, and the control group was the patients who could continue to receive cetuximab. The efficacy and safety of the two groups were compared. Results After propensity score matching, the median progression-free survival of the observation group and the control group were 10.5 months (95% confidence interval: 9.3-11.7 months) and 10.8 months (95% confidence interval: 9.4-12.2 months), respectively, and there was no significant difference between the two groups (P=0.28). The median overall survival was 27.1 months (95% confidence interval: 22.9-31.3 months) and 33.5 months (95% confidence interval: 25.9-41.0 months), respectively, and there was no significant difference between the two groups (P=0.17). During the treatment, the proportion of skin toxicity in the observation group was lower than that in the control group (P<0.05), and there was no significant difference in the incidence of other adverse reactions between the two groups (all P>0.05). Conclusion Switching to bevacizumab is also a treatment option for patients with RAS wild-type mCRC who cannot tolerate cetuximab skin toxicity during first-line therapy.