colorectal cancer (CRC)

结直肠癌 (CRC)
  • 文章类型: Journal Article
    查耳酮和二氢查耳酮(DHCs)是分离自中药的重要生物活性天然产物(BNPs)。在这项研究中,13个查尔酮的设计灵感来自Loureirin,从ResinaDraconis中提取的DHC,并通过经典的Claisen-Schmidt反应合成。然后进行还原反应以获得相应的DHC。细胞毒性实验表明,查耳酮和DHC对大肠癌(CRC)细胞具有选择性的细胞毒性。这些化合物的初步结构-活性关系(SAR)表明α,查耳酮的β-不饱和酮对抗癌活性至关重要。有趣的是,化合物3d和4c对CRC细胞系HCT116表现出选择性抗癌活性,IC50为8.4和17.9μM,但不正常细胞。此外,4c还可以抑制CRC细胞的迁移和侵袭。机制研究表明,4c可以通过调节细胞周期相关蛋白诱导细胞周期G2/M阻滞,也可以上调Fas细胞表面死亡受体。虚拟对接进一步指出,化合物3d和4c可以很好地结合Fas/FADD死亡域复合物(ID:3EZQ)。此外,沉默Fas可显著增强CRC细胞的增殖,并减弱4c诱导的细胞毒性。这些结果表明4c发挥了其抗癌活性,可能调节细胞周期和Fas死亡受体。总之,这项研究调查了Loureirin类似物在CRC中的抗癌活性和机制,提示这些化合物作为有希望的候选抗癌药物用于CRC的治疗可能需要进一步研究.
    Chalcones and dihydrochalcones (DHCs) are important bioactive natural products (BNPs) isolated from traditional Chinese medicine. In this study, 13 chalcones were designed with the inspiration of Loureirin, a DHC extracted from Resina Draconis, and synthesized by classical Claisen-Schmidt reactions. Afterwards the reduction reactions were carried out to obtain the corresponding DHCs. Cytotoxicity assay indicated chalcones and DHCs possessed selective cytotoxicity against colorectal cancer (CRC) cells. The preliminary structure-activity relationships (SAR) of these compounds suggested the α, β-unsaturated ketone of the chalcones were crucial for the anticancer activity. Interestingly, compounds 3d and 4c exhibited selective anticancer activity against CRC cell line HCT116 with IC50s of 8.4 and 17.9 μM but not normal cell. Moreover, 4c could also inhibit the migration and invasion of CRC cells. Mechanism investigations showed 4c could induce cell cycle G2/M arrest by regulating cell cycle-associated proteins and could also up-regulate Fas cell surface death receptor. The virtual docking further pointed out that compounds 3d and 4c could nicely bind to the Fas/FADD death domain complex (ID: 3EZQ). Furthermore, silencing of Fas significantly enhanced the proliferation of CRC cells and attenuated the cytotoxicity induced by 4c. These results suggested 4c exerted its anticancer activity possibly regulating cell cycle and Fas death receptor. In summary, this study investigated the anticancer activity and mechanism of Loureirin analogues in CRC, suggesting these compounds may warrant further investigation as promising anticancer drug candidates for the treatment of CRC.
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  • 文章类型: Journal Article
    转移是癌症相关死亡的主要原因,结直肠癌(CRC)肝转移是CRC的主要不良预后因素。NAT1(N-乙酰转移酶1)在大肠癌的侵袭和转移过程中起着至关重要的作用。通过建立NAT1过表达和敲低的细胞模型,验证NAT1对肿瘤细胞的作用和分子机制,并通过建立结直肠癌肝转移模型进行动物实验进一步验证。体内和体外实验表明,NAT1的过表达降低了结直肠癌细胞的转移和侵袭能力。NAT1过表达抑制PI3K/AKT/mTOR信号通路,从而抑制肿瘤细胞的EMT(上皮-间质转化)过程和糖酵解能力。此外,糖酵解能力降低导致结直肠癌细胞VEGF(血管内皮生长因子)表达降低。VEGF表达降低导致肝转移瘤血管生成和血管通透性降低,最终减少肝转移的发生。我们的发现强调NAT1的过表达显著抑制PI3K/AKT/mTOR信号通路,从而抑制EMT,糖酵解能力,和VEGF在大肠癌细胞中的表达,共同预防肝转移的发展。
    Metastasis is the primary cause of cancer-related deaths, and colorectal cancer (CRC) liver metastasis is a major poor prognostic factor in CRC. NAT1 (N-acetyltransferase 1) plays a crucial role in the invasive and metastatic processes of colorectal cancer. The role and molecular mechanism of NAT1 on tumor cells were verified by establishing a cell model of overexpression and knockdown of NAT1, and further verified by establishing a liver metastasis model of colorectal cancer for animal experiments. In vivo and in vitro experiments have demonstrated that overexpression of NAT1 reduces the ability of metastasis and invasion of colorectal cancer cells. NAT1 overexpression inhibits the PI3K/AKT/mTOR signaling pathway, thereby suppressing the EMT (epithelial-mesenchymal transition) process and glycolytic ability of tumor cells. Additionally, decreased glycolytic ability results in reduced VEGF (Vascular endothelial growth factor) expression in colorectal cancer cells. The decreased VEGF expression leads to decreased angiogenesis and vascular permeability in liver metastases, ultimately reducing the occurrence of liver metastasis. Our findings highlight that overexpression of NAT1 significantly inhibits the PI3K/AKT/mTOR signaling pathway, thereby suppressing EMT, glycolytic ability, and VEGF expression in colorectal cancer cells, collectively preventing the development of liver metastasis.
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  • 文章类型: Journal Article
    信号转导和转录激活因子3(STAT3)已被确立为抗肿瘤药物开发中的关键药物靶标。在这项研究中,设计并合成了一系列STAT3抑制剂napabucasin的21种衍生物。通过对肿瘤细胞系的初步筛选,SZ6是最有效的化合物,半数最大抑制浓度(IC50)值为46.3nM,66.4nM,分别针对HCT116、HepG2和Hela细胞和53.8nM。此外,SZ6通过抑制蛋白激酶B(PKB/AKT)活性和诱导活性氧(ROS)来诱导S期停滞和凋亡,从而在HCT116细胞试验中有效抑制了肿瘤的侵袭和迁移。SZ6的作用机制涉及抑制STAT3磷酸化,通过蛋白质印迹分析证实了这一点。此外,表面等离子体共振(SPR)和细胞热移位测定(CETSA)证明了SZ6和STAT3之间的直接结合。值得注意的是,体内研究表明,SZ6显著抑制肿瘤生长,没有任何观察到的器官毒性。总的来说,这些发现确定SZ6是一种有前景的用于结直肠癌治疗的STAT3抑制剂.
    The signal transducer and activator of transcription 3 (STAT3) has been established as a crucial drug target in the development of antitumor agents. In this study, a series of 21 derivatives of the STAT3 inhibitor napabucasin were designed and synthesized. Through preliminary screening against tumor cell lines, SZ6 emerged as the most potent compound with half maximal inhibitory concentration (IC50) values of 46.3 nM, 66.4 nM, and 53.8 nM against HCT116, HepG2, and Hela cells respectively. Furthermore, SZ6 effectively suppressed tumor invasion and migration in HCT116 cell assays by inducing S-phase arrest and apoptosis through inhibition of Protein Kinase B (PKB/AKT) activity and induction of reactive oxygen species (ROS). The mechanism underlying SZ6\'s action involves inhibition of STAT3 phosphorylation, which was confirmed by western blotting analysis. Additionally, surface plasmon resonance (SPR) and cellular thermal shift assay (CETSA) demonstrated direct binding between SZ6 and STAT3. Notably, in vivo studies revealed that SZ6 significantly inhibited tumor growth without any observed organ toxicity. Collectively, these findings identify SZ6 as a promising STAT3 inhibitor for colorectal cancer treatment.
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  • 文章类型: Journal Article
    背景:结直肠癌(CRC)是世界上第三大恶性肿瘤。基于5-氟尿嘧啶(5-FU)的化疗是CRC的一线化疗方案,而获得性耐药对治疗CRC患者构成巨大障碍,其机制仍不清楚。因此,鉴定与5-FU化疗相关的基因并寻求二线治疗是改善CRC患者生存和预后的必要手段。
    方法:使用癌症治疗反应门户(CTRP)数据库和癌症药物敏感性基因组学(GDSC)数据库来鉴定CRC相关基因和5-FU耐药CRC的潜在二线治疗。从GEO数据集获得CRC组织的单细胞RNA测序数据。在体外和体内模型中研究了ITGA2和5-FU抗性之间的关系。
    结果:ACOX1和ITGA2被确定为与5-FU耐药相关的风险生物标志物。我们开发了一个风险签名,由ACOX1和ITGA2组成,能够很好地区分5-FU抗性和5-FU敏感性。单细胞测序数据显示,ITGA2主要富集在恶性细胞中。ITGA2与大多数小分子抑制剂的IC50值呈负相关,其中司米替尼的负相关性最高。最后,敲低ITGA2可以使5-FU耐药CRC细胞对5-FU敏感,联合司美替尼可以提高5-FU耐药细胞的治疗效果。
    结论:总之,我们的研究结果证明了ITGA2在增强CRC细胞化疗耐药中的关键作用,并提示司美替尼可以通过抑制ITGA2表达恢复化疗耐药CRC细胞对5-FU的敏感性.
    BACKGROUND: Colorectal cancer (CRC) is the third most malignant tumor in the world. 5-fluorouracil (5‑FU) -based chemotherapy is the first-line chemotherapy scheme for CRC, whereas acquired drug resistance poses a huge obstacle to curing CRC patients and the mechanism is still obscure. Therefore, identification of genes associated with 5‑FU chemotherapy and seeking second-line treatment are necessary means to improve survival and prognosis of patients with CRC.
    METHODS: The Cancer Therapeutics Response Portal (CTRP) database and Genomics of Drug Sensitivity in Cancer (GDSC) database were used to identify CRC-related genes and potential second-line therapies for 5-FU-resistant CRC. The single-cell RNA sequencing data for CRC tissues were obtained from a GEO dataset. The relationship between ITGA2 and 5-FU-resistant was investigated in vitro and in vivo models.
    RESULTS: ACOX1 and ITGA2 were identified as risk biomarkers associated with 5-FU-resistance. We developed a risk signature, consisting of ACOX1 and ITGA2, that was able to distinguish well between 5-FU-resistance and 5-FU-sensitive. The single-cell sequencing data showed that ITGA2 was mainly enriched in malignant cells. ITGA2 was negatively correlated with IC50 values of most small molecule inhibitors, of which selumetinib had the highest negative correlation. Finally, knocking down ITGA2 can make 5-FU-resistant CRC cells sensitive to 5-FU and combining with selumetinib can improve the therapeutic effect of 5-FU resistant cells.
    CONCLUSIONS: In summary, our findings demonstrated the critical role of ITGA2 in enhancing chemotherapy resistance in CRC cells and suggested that selumetinib can restore the sensitivity of chemotherapy-resistant CRC cells to 5-FU by inhibiting ITGA2 expression.
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  • 文章类型: Journal Article
    背景:核孔复合物(NPC)是细胞的核包膜中根深蒂固的结构,其调节诸如蛋白质和RNA的物质的核-细胞质运输以使细胞正常运作。蛋白质和RNA在细胞内的适当定位对于其正常功能至关重要。对于如此复杂的跨越NPC的材料运输,大约有60种蛋白质参与其中,包括核孔蛋白,在NPC的结构形成中起重要作用的核动力蛋白和RAN系统蛋白,跨NPC的货物转运,和货物分别是快速定向运输。在各种癌症中,NPC的结构和功能经常被夸大,在其核孔蛋白和核动力蛋白的表达改变后,影响相关信号通路的其他蛋白质。目前的一些核调素抑制剂具有调节这些核调素分子的改变的水平/表达的潜力。
    目的:这篇综述总结了1990年至2023年的数据,主要集中在说明NPC结构和功能的最新研究,核孔蛋白和核蛋白与结直肠癌的关系和机制,以及治疗价值,为了了解与NPC相关的结直肠癌的病理和基础。这是我们知识的第一次综述,阐明了针对NPC结直肠癌的详细更新研究。该审查还旨在针对某些核动力蛋白,Nups及其可能的抑制剂和激活剂分子作为治疗策略。
    NPC结构提供了理解,作为关键分子的核孔蛋白和核蛋白如何负责适当的核质运输。许多研究提供了描述破坏的核孔蛋白和核动力蛋白不仅在CRC中而且在其他非血液和血液恶性肿瘤中的作用的证据。目前,一些核蛋白抑制剂对CRC有治疗潜力,然而,开发更有效的抑制剂可能在不久的将来为CRC提供更有效的治疗策略.
    BACKGROUND: Nuclear pore complexes (NPCs) are the architectures entrenched in nuclear envelop of a cell that regulate the nucleo-cytoplasmic transportation of materials, such as proteins and RNAs for proper functioning of a cell. The appropriate localization of proteins and RNAs within the cell is essential for its normal functionality. For such a complex transportation of materials across the NPC, around 60 proteins are involved comprising nucleoporins, karyopherins and RAN system proteins that play a vital role in NPC\'s structure formation, cargo translocation across NPC, and cargoes\' rapid directed transportation respectively. In various cancers, the structure and function of NPC is often exaggerated, following altered expressions of its nucleoporins and karyopherins, affecting other proteins of associated signaling pathways. Some inhibitors of karyopherins at present, have potential to regulate the altered level/expression of these karyopherin molecules.
    OBJECTIVE: This review summarizes the data from 1990 to 2023, mainly focusing on recent studies that illustrate the structure and function of NPC, the relationship and mechanisms of nucleoporins and karyopherins with colorectal cancer, as well as therapeutic values, in order to understand the pathology and underlying basis of colorectal cancer associated with NPC. This is the first review to our knowledge elucidating the detailed updated studies targeting colorectal cancer at NPC. The review also aims to target certain karyopherins, Nups and their possible inhibitors and activators molecules as a therapeutic strategy.
    UNASSIGNED: NPC structure provides understanding, how nucleoporins and karyopherins as key molecules are responsible for appropriate nucleocytoplasmic transportation. Many studies provide evidences, describing the role of disrupted nucleoporins and karyopherins not only in CRC but also in other non-hematological and hematological malignancies. At present, some inhibitors of karyopherins have therapeutic potential for CRC, however development of more potent inhibitors may provide more effective therapeutic strategies for CRC in near future.
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  • 文章类型: Journal Article
    背景:热凋亡属于一种独特的程序性细胞死亡类型,其中据报道GSDME发挥抗肿瘤免疫力。然而,如何增强肿瘤浸润淋巴细胞的潜在机制以及是否对ICIs的疗效有益尚不清楚.
    方法:使用CRC样本分析其与CD8+T细胞的关系。GSDME在小鼠CRC细胞系CT26/MC38中过表达。通过多重流式细胞术分析和免疫组织化学确定移植肿瘤中CD8T细胞的浸润。在细胞系中进行转录组学分析以定义与其过表达相关的关键特征。观察了GSDME诱导的线粒体损伤和激活的cGAS-STING通路如何释放mtDNA的机制。研究了GSDME是否使ICI受益以及与CRC患者基因型的关系。
    结果:它在CRC中具有良好的预后价值,并且与人类样品和动物模型中CD8+T细胞数量和功能的增加呈正相关。这是由于线粒体损伤和cGAS-STING-IFNβ途径的激活以募集CD8+T细胞。机械上,GSDME过表达可提高N-GSDME水平,导致线粒体损伤,mtDNA被释放到细胞质中。最后,GSDME受益于ICI,并与CRC患者的MSI呈正相关。
    结论:我们提出了GSDME通过激活线粒体损伤介导的cGAS-STING-IFNβ轴参与抗肿瘤免疫的机制。导致更多的CD8+T细胞浸润,与ICIs具有协同作用。
    BACKGROUND: Pyroptosis belongs to a unique type of programmed cell death among which GSDME is reported to exert anti-tumor immunity. However, the underlying mechanisms of how to boost tumor-infiltrating lymphocytes and whether it could benefit the efficacy of ICIs are still unknown.
    METHODS: CRC samples were used to analyze its relationship with CD8+T cells. GSDME in mouse CRC cell lines CT26/MC38 was overexpressed. The infiltration of CD8+T cells in grafted tumors was determined by multiplex flow cytometric analysis and immunohistochemistry. Transcriptomic analysis was performed in cell lines to define key signatures related to its overexpression. The mechanism of how mtDNA was released by GSDME-induced mitochondrial damage and activated cGAS-STING pathway was observed. Whether GSDME benefited ICIs and the relationships with the genotypes of CRC patients were investigated.
    RESULTS: It had favorable prognostic value in CRC and was positively associated with increased number and functionality of CD8+T cells both in human samples and animal models. This was due to mitochondrial damage and activation of cGAS-STING-IFNβ pathway for the recruitment of CD8+T cells. Mechanically, GSDME overexpression enhanced N-GSDME level, leading to the mitochondrial damage and mtDNA was released into cytosol. Finally, GSDME benefited with ICIs and exhibited positive relationships with MSI in CRC patients.
    CONCLUSIONS: We presented the mechanism of GSDME in anti-tumor immunity through activating cGAS-STING-IFNβ axis mediated by mitochondrial damage, leading to more infiltration of CD8+T cells with synergistic efficacy with ICIs.
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  • 文章类型: Journal Article
    TH1L(也称为NELF-C/D)是负延伸因子(NELF)复合物的成员,它是调节RNA聚合酶II(RNAPII)暂停和转录延伸的后生动物特异性因子。然而,TH1L在癌症进展中的功能和分子机制仍在很大程度上未知。在这项研究中,我们发现TH1L在结直肠癌(CRC)组织和CRC患者粪便中高表达.过表达TH1L显著增强CRC细胞的增殖和迁移,而它的击倒明显抑制了这些过程。在机制上,RNA测序显示CCL20在TH1L过表达的CRC细胞中上调,导致NF-κB信号通路的激活。挽救试验表明,CCL20的敲低可以削弱THIL在CRC细胞中的肿瘤促进作用。一起来看,这些结果表明,TH1L可能通过CCL20/NF-κB信号通路在CRC增殖和迁移中发挥重要作用,并可能成为CRC诊断和治疗的潜在靶点.
    TH1L (also known as NELF-C/D) is a member of the Negative Elongation Factor (NELF) complex, which is a metazoan-specific factor that regulates RNA Polymerase II (RNAPII) pausing and transcription elongation. However, the function and molecular mechanisms of TH1L in cancer progression are still largely unknown. In this study, we found that TH1L was highly expressed in colorectal cancer (CRC) tissues and the faeces of CRC patients. Overexpression of TH1L significantly enhanced the proliferation and migration of CRC cells, while its knockdown markedly suppressed these processes. In mechanism, RNA sequencing revealed that CCL20 was upregulated in TH1L-overexpressed CRC cells, leading to activation of the NF-κB signalling pathway. Rescue assays showed that knockdown of CCL20 could impair the tumour-promoting effects of THIL in CRC cells. Taken together, these results suggest that TH1L may play a vital role via the CCL20/NF-κB signalling pathway in CRC proliferation and migration and may serve as a potential target for diagnosis and therapy of CRC.
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  • 文章类型: Journal Article
    结直肠癌(CRC)是全球普遍存在的恶性肿瘤。CRC发病机制中的一个关键事件涉及APC基因的功能缺失突变,导致良性息肉的形成。尽管APC的作用已经确立,对于CUL4B在肿瘤前阶段对CRC启动的贡献仍然知之甚少.在这次调查中,我们通过将ApcMin/+小鼠与Cul4bΔIEC小鼠交叉以在ApcMin/+背景下实现肠上皮中Cul4b的特异性缺失来产生小鼠模型。通过采用组织学方法,RNA测序(RNA-seq),和流式细胞术,我们评估了改变并表征了免疫微环境。我们的结果揭示了肠上皮中的CUL4B缺乏加速了ApcMin/腺瘤的形成。值得注意的是,腺瘤中的CUL4B抑制了肿瘤浸润性髓源性抑制细胞(MDSC)的积累。MDSC的体内抑制显著延迟了CUL4B缺失的ApcMin/+腺瘤的生长。此外,向体外培养的ApcMin/+;Cul4bΔIEC腺瘤类器官中添加MDSCs减轻了它们的改变。机械上,CUL4B通过与PRC2协调,直接与Csf3的启动子相互作用,Csf3是编码粒细胞集落刺激因子(G-CSF)的基因。抑制CUL4B表观遗传激活G-CSF的表达,促进招募MDSCs。这些发现为CUL4B在调节ApcMin/+腺瘤中的肿瘤抑制因子样作用提供了新的见解。提示在激活的Wnt信号背景下,CRC起始和进展的潜在治疗策略。
    Colorectal cancer (CRC) stands as a prevalent malignancy globally. A pivotal event in CRC pathogenesis involves the loss-of-function mutation in the APC gene, leading to the formation of benign polyps. Despite the well-established role of APC, the contribution of CUL4B to CRC initiation in the pre-tumorous stage remains poorly understood. In this investigation, we generated a murine model by crossing ApcMin/+ mice with Cul4bΔIEC mice to achieve specific deletion of Cul4b in the gut epithelium against an ApcMin/+ background. By employing histological methods, RNA-sequencing (RNA-seq), and flow cytometry, we assessed alterations and characterized the immune microenvironment. Our results unveiled that CUL4B deficiency in gut epithelium expedited ApcMin/+ adenoma formation. Notably, CUL4B in adenomas restrained the accumulation of tumor-infiltrating myeloid-derived suppressor cells (MDSCs). In vivo inhibition of MDSCs significantly delayed the growth of CUL4B deleted ApcMin/+ adenomas. Furthermore, the addition of MDSCs to in vitro cultured ApcMin/+; Cul4bΔIEC adenoma organoids mitigated their alterations. Mechanistically, CUL4B directly interacted with the promoter of Csf3, the gene encoding granulocyte-colony stimulating factor (G-CSF) by coordinating with PRC2. Inhibiting CUL4B epigenetically activated the expression of G-CSF, promoting the recruitment of MDSCs. These findings offer novel insights into the tumor suppressor-like roles of CUL4B in regulating ApcMin/+ adenomas, suggesting a potential therapeutic strategy for CRC initiation and progression in the context of activated Wnt signaling.
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  • 文章类型: Journal Article
    一些研究表明,在难治性转移性结直肠癌(mCRC)中,氟尿苷/替吡嘧啶(TAS-102)加贝伐单抗(BEV)的疗效优于TAS-102的单一疗法。然而,目前尚不清楚中国人口是否可以从这种组合中受益。因此,我们进行了这项回顾性队列研究,以比较TAS-102联合BEV与TAS-102单药治疗难治性mCRC的疗效和安全性.
    这项回顾性队列研究纳入了湖南省肿瘤医院难治性mCRC患者(任何年龄)。主要纳入标准是组织病理学和/或影像学证实的难治性mCRC,世界卫生组织(WHO)的表现状态为0至2,器官功能充足,以及在2020年11月至2022年10月期间有或没有BEV的TAS-102的初始治疗。以前使用氟喹替尼或瑞戈非尼的治疗是允许的,但不是强制性的。适当收集基线人口统计学和临床特征。每2或3个治疗周期,通过计算机断层扫描(CT)扫描和临床评估对患者进行评估,直至疾病进展或失去随访.美国国家癌症研究所常见不良事件术语标准5.0(NCI-CTCAE5.0)表示为n(%)。主要终点是研究者评估的总生存期(OS)。由于这是一项回顾性队列研究,未进行样本量计算。将尽可能多地招募符合条件的患者。
    共纳入90名患者,包括58例接受TAS-102加BEV治疗的患者和另外32例接受TAS-102单药治疗的患者.已知的基线特征具有可比性(P<0.05)。中位随访时间为4.60个月(范围,0.20-22.80),TAS-102加BEV组的中位OS(mOS)时间长于TAS-102单药治疗组(10.83vs.7.43个月),但差异无统计学意义(P=0.79)。两组的中位无进展生存期(mPFS)时间具有可比性(4.67vs.4.30个月,P=0.96)。多因素Cox回归分析表明,在TAS-102后接受治疗或不使用BEV是OS的独立危险因素[风险比(HR)=0.25;95%置信区间(CI):0.09-0.71,P<0.01]。和先前使用西妥昔单抗治疗是PFS的独立保护因素(HR=0.17;95%CI:0.03-0.91,P=0.04)。在接受评估的70名患者中,与接受TAS-102单药治疗的患者相比,接受TAS-102+BEV的患者显示出更高的客观缓解率(ORR)和疾病控制率(DCR)的趋势(分别为P=0.16和P=0.29).两组不良事件(AE)相似,除了TAS-102+BEV组血小板计数下降(≥3级)的发生率显著较高.
    在OS和DCR方面,有一种趋势是支持BEV加TAS-102的组合,没有达到统计意义,这意味着在疗效方面没有明显的优势。进一步的前瞻性研究仍需得出明确的结论。
    UNASSIGNED: Several studies demonstrated trifluridine/tipiracil (TAS-102) plus bevacizumab (BEV) had better efficacy than the monotherapy of TAS-102 in refractory metastatic colorectal cancer (mCRC). However, it remains unclear whether Chinese population can benefit from this combination or not. Hence, we conducted this retrospective cohort study to compare the efficacy and safety between TAS-102 plus BEV with TAS-102 monotherapy in refractory mCRC.
    UNASSIGNED: This retrospective cohort study enrolled patients (any age) with refractory mCRC from Hunan Cancer Hospital. The main inclusion criteria were histopathologically and/or radiographically confirmed refractory mCRC, World Health Organization (WHO) performance status of 0 to 2, adequate organ function, and initial treatment of TAS-102 with or without BEV between November 2020 and October 2022. Previous therapy with fruquintinib or regorafenib was allowed but not mandatory. Baseline demographic and clinical characteristics were collected appropriately. Every 2 or 3 treatment cycles, the patients were assessed by computed tomography (CT) scans and clinical assessments until disease progression or loss to follow-up. The National Cancer Institute Common Terminology Criteria for Adverse Events 5.0 (NCI-CTCAE 5.0) were presented as n (%). The primary endpoint was investigator-evaluated overall survival (OS). As this is a retrospective cohort study, sample size calculation was not performed. Eligible patients would be enrolled as many as possible.
    UNASSIGNED: A total of 90 patients were enrolled, including 58 patients who received TAS-102 plus BEV and another 32 patients who received TAS-102 monotherapy. The known baseline characteristics were comparable (P<0.05). With a median follow-up of 4.60 months (range, 0.20-22.80), the median OS (mOS) time in the TAS-102 plus BEV group was longer than that in the TAS-102 monotherapy group (10.83 vs. 7.43 months), but the difference was not significant (P=0.79). The median progression-free survival (mPFS) time was comparable between the two groups (4.67 vs. 4.30 months, P=0.96). Multivariate Cox regression analysis demonstrated that undergoing therapy after TAS-102 either with or without BEV was an independent risk factor for OS [hazard ratio (HR) =0.25; 95% confidence interval (CI): 0.09-0.71, P<0.01], and previous treatment with cetuximab was an independent protective factor for PFS (HR =0.17; 95% CI: 0.03-0.91, P=0.04). Of the 70 patients who were evaluated, those receiving TAS-102 plus BEV showed trend of a higher objective response rate (ORR) and disease control rate (DCR) than those who received TAS-102 monotherapy (P=0.16 and P=0.29, respectively). Adverse events (AEs) were similar between the two groups, except that the incidence of platelet count decrease (grade ≥3) was significantly higher in the TAS-102 plus BEV group.
    UNASSIGNED: There was a trend in favor of the combination of BEV plus TAS-102 regarding OS and DCR, without reaching statistical significance, and it means that there was no clear advantage of one over the other in terms of efficacy. Further prospective studies are still necessary to draw a definite conclusion.
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