癌症,往往使病人感到徬徨無助,如能把握時機,接受適切的專業治療,就能大大提升治癒機會。陳亮祖醫生,會定期到非牟利團體,為有需要的病人提供專業意見,並緊貼醫學發展,出席國際性的醫學會議,了解最新的醫學資訊。除此之外,陳亮祖醫生亦會在健康講座擔任主講嘉賓,以及向其他醫生演講,分享醫學知識及經驗。
2015年11月5日 星期四
Continuum of care for colorectal cancer: Finding the optimal treatment course (2)
Discussion
The continuum-of-care approach in CRC emphasizes individualized therapy that exposes patient to different combinations of cytotoxic and targeted agents. Physicians can utilize, discontinue, or re-use agents across several lines of treatment, according to factors such as: treatment goals; patient preference; patient’s general condition; disease characteristics; and efficacy and tolerability profiles of the drugs. However, the choice of first-line treatment affects which subsequent treatment options can be used, and physicians often undergo an intensive discussion of benefits and risks with patients and their families before each treatment decision.
Patients with unresectable disease but without other tumour-related symptoms are generally offered a doublet cytotoxic regimen, such as oxaliplatin with a fluoropyrimidine, and a targeted agent, for disease control. Current clinical evidence favours bevacizumab in the first-line setting, but KRAS wild-type tumours may benefit from an anti-epidermal growth factor receptor antibody. Upon progression, oxaliplatin or irinotecan may be offered in a sequential manner, along with a targeted biological agent. As second-line treatment, the clinical benefit of the antiangiogenic agent aflibercept was demonstrated in VELUR, a phase III, randomized, placebo-controlled trial. Aflibercept with 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) significantly improved overall survival (13.50 versus 12.06 months; hazard ratio [HR] 0.817; 95% confidence interval [CI] 0.713-0.937; p<0.0032) and progression-free survival (6.90 vs 4.67 months; HR 0.758; 95% CI 0.661-0.869; p<0.0001) in patients with mCRC previously treated with an oxaliplatin-based regimen, including those who had received bevacizumab. In the present case, the distinct mechanisms of action of irinotecan and aflibercept may have contributed to the patient’s good response. Her regimen appears effective and is also particularly suitable for patients who have a preference for convenient outpatient treatment.
Reference information: www.cancerdoctor.hk
The information aims to provide educational purpose only. Anyone reading it should consult Oncologist before considering treatment and should not rely on the information above.
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