PDF(Pubmed)
Abstract：
This systematic review critically evaluates the impact of systemic treatments on outcomes and quality of life (QoL) in patients with RAS-positive stage IV colorectal cancer, with studies published up to December 2023 across PubMed, Scopus, and Web of Science. From an initial pool of 1345 articles, 11 relevant studies were selected for inclusion, encompassing a diverse range of systemic treatments, including panitumumab combined with FOLFOX4 and FOLFIRI, irinotecan paired with panitumumab, regorafenib followed by cetuximab ± irinotecan and vice versa, and panitumumab as a maintenance therapy post-induction. Patient demographics predominantly included middle-aged to elderly individuals, with a slight male predominance. Racial composition, where reported, showed a majority of Caucasian participants, highlighting the need for broader demographic inclusivity in future research. Key findings revealed that the addition of panitumumab to chemotherapy (FOLFOX4 or FOLFIRI) did not significantly compromise QoL while notably improving disease-free survival, with baseline EQ-5D HSI mean scores ranging from 0.76 to 0.78 and VAS mean scores from 70.1 to 74.1. Improvements in FACT-C scores and EQ-5D Index scores particularly favored panitumumab plus best supportive care in KRAS wild-type mCRC, with early dropout rates of 38-42% for panitumumab + BSC. Notably, cetuximab + FOLFIRI was associated with a median survival of 25.7 months versus 16.4 months for FOLFIRI alone, emphasizing the potential benefits of integrating targeted therapies with chemotherapy. In conclusion, the review underscores the significant impact of systemic treatments, particularly targeted therapies and their combinations with chemotherapy, on survival outcomes and QoL in patients with RAS-positive stage IV colorectal cancer, and the need for personalized treatment.
摘要：
这项系统评价严格评估了系统性治疗对RAS阳性IV期结直肠癌患者的预后和生活质量（QoL）的影响。随着截至2023年12月在PubMed上发表的研究，Scopus,和WebofScience。从最初的1345篇文章中，11项相关研究入选，包括各种各样的系统治疗，包括帕尼单抗联合FOLFOX4和FOLFIRI，伊立替康与帕尼单抗配对,瑞戈非尼，然后是西妥昔单抗±伊立替康，反之亦然，和帕尼单抗作为诱导后的维持治疗。患者人口统计学主要包括中老年人，有轻微的男性优势。种族组成，据报道，显示了大多数白种人的参与者，强调在未来的研究中需要更广泛的人口包容性。主要研究结果表明，在化疗（FOLFOX4或FOLFIRI）中添加帕尼单抗并没有显着影响QoL，同时显着改善无病生存率。基线EQ-5DHSI平均得分为0.76至0.78，VAS平均得分为70.1至74.1。FACT-C评分和EQ-5D指数评分的改善尤其有利于帕尼单抗加KRAS野生型mCRC的最佳支持治疗，帕尼单抗+BSC的早期辍学率为38-42%。值得注意的是,西妥昔单抗+FOLFIRI的中位生存期为25.7个月,而单独使用FOLFIRI的中位生存期为16.4个月,强调将靶向治疗与化疗相结合的潜在益处。总之,这篇综述强调了系统治疗的重大影响，特别是靶向治疗及其与化疗的组合，RAS阳性IV期结直肠癌患者的生存结局和QoL，以及个性化治疗的需要。
