Metastatik kolorektal kanserin üçüncü basamak tedavisinde oksaliplatin veya irinotekan rechallenge tedavi ile regorafenib karşılaştırması

The comparison of oxaliplatin or irinotecan rechallenge treatment with regorafenib in the third-line treatment of metastatic colorectal cancer

Doğan UNCU, Gökhan UÇAR, Öznur BAL, Mutlu DOĞAN, Yusuf AÇIKGÖZ, Merve DİRİKOÇ, Yakup ERGÜN

Özet

GİRİŞ ve AMAÇ: Bu çalışmada iki basamak standart tedavi almış metastatik kolorektal kanser (mKRK) tanılı hastalarda oksaliplatin ya da irinotekan bazlı rejimlerin yeniden verildiği (rechallenge) hastalar ile regorafenib alan hastaların gerçek yaşam verilerinin karşılaştırılması amaçlandı. YÖNTEM ve GEREÇLER: Ocak 2010 ve Aralık 2017 tarihleri arasında merkezimizde mKRK tanısıyla takip edilen 427 hastanın verileri retrospektif olarak değerlendirilip, iki basamak stardart kemoterapi sonrası progresyon nedeniyle rechallenge kemoterapi (n: 40) veya regorafenib (n: 21) alan 61 hasta çalışmaya alındı. BULGULAR: Medyan takip süresi 7.1 aydı (aralık; 2.2–41.6). Hiçbir hastamızda tam yanıt gözlenmez iken parsiyel yanıt rechallenge grubunda %17, regorafenib grubunda ise %5 olarak bulundu (p=0.2). Rechallenge grubunda ortanca genel sağkalım (GSK) 9.6 ay (%95 CI 7.3–13.3) iken regorafenib grubunda 7 ay (1.9–17) olup istatistiksel olarak fark yoktu (Hazard oranı [HR]: 1.05; %95 Güven aralığı [GA] 0.5–2.1, p=0.9). Ortanca progresyonsuz sağkalım da (PSK) her iki grupta benzerdi (sırasıyla; 4.7 ay ve 3.1 ay, HR: 1.45; 95% GA 0.82– 2.5, p=0.1). Rechallenge grubundaki hastalar önceki tedavilerinde tedavisiz süre (TS)

Abstract

INTRODUCTION: In this study, we aimed to compare the results of regorafenib with those of oxaliplatin oririnotecan based rechallenge therapy as the third-line treatments for metastatic colorectal cancer (mCRC).METHODS: Between January 2010 and December 2017, data of 427 mCRC patients were evaluatedretrospectively. Sixty one mCRC patients who received regorafenib (n: 21) or rechallenge therapy (n: 40) asthird-line setting were included.RESULTS: Median follow-up was 7.1 months (range; 2.2–41.6). While no complete response was observed inany of our patients, the partial response was 17% in the rechallenge group and 5% in the regorafenib group(p=0.2). In the Rechallenge group, the median OS was 9.6 months (95% CI 7.3–13.3), while in the regorafenibgroup 7 months (1.9–17) there was no statistically significant difference (HR: 1.05; 95% CI 0.5–2.1, p=0.9).Median progression-free survival (PFS) was similar in both groups (4.7 and 3.1 months, HR: 1.45; 95% CI 0.82–2.5, p=0.1). Although median PFS (6.7 months and 4 months, p = 0.4) and OS (10.3 and 7.1 months, p = 0.1)were numerically better in treatment free-interval (TFI) ≥6 months group, this difference was not statisticallysignificant.DISCUSSION AND CONCLUSION: According to our findings, regorafenib with rechallenge treatment issimilar activity. Based on these data, rechallenge therapy in this patient group with poor prognosis may be analternative treatment option in the third step or a regimen that can be preferred in the next steps in the patientswho are scheduled with the recommended treatments. However, due to the small number of our patients and theretrospective nature of our study, prospective randomized trials with large number of patients are needed in thisarea.