Text / Chai Yan
In recent years, colorectal cancer in China rate showed an upward trend year after year, with the deepening of the research on the pathogenesis of, for the diagnosis and treatment of colorectal cancer provides more basis, gradually become individualized treatment plan is developed. At present, the molecular targeted therapy of colorectal cancer has been widely used in clinical application, and the efficacy of traditional methods in combination with chemotherapy has been recognized by more experts. As a global first to epidermal growth factor receptor (epidermal growth factor receptor, EGFR) as the target of the humanized monoclonal antibody drug, Nigeria properly natalizumab (nimotuzumab, the name of the commodity, Xintai students & reg;) in the colorectal cancer clinical application rarely reported in the literature. Combined with our recent diagnosis and treatment of 1 cases of colorectal cancer cases, to explore the efficacy of rituximab in colorectal cancer.
case
Female, 60 years old. 33 months after surgery, the liver metastasis was found in 2 months after the operation of the external hospital (straight B junction), and 1 years later. Patients with rectal resection under general anesthesia in September 14, 2006, postoperative pathology: (straight B junction) ulcer type high - middle differentiated adenocarcinoma, lymph node metastasis and cancer 21/23. Postoperative chemotherapy with FOLFOX regimen for six cycles. Review of abdominal CT in June 2007: right lobe of the liver, gallbladder stones, retroperitoneal lymph node enlargement. With CapoX chemotherapy, oxaliplatin induced allergic reactions occur. After continuous oral xeloda. Review in February 25, 2008, found that the left lung nodules, liver can be seen in low density mass, retroperitoneal lymph node enlargement, left ureteral dilation, with left renal pelvic effusion. Give the line FOLFIRI four cycle, the emergence of IV grade gastrointestinal reactions, electrolyte disorder. Then maintain xeloda. November 2008 review, found third lumbar bone metastases. Give oral xeloda combined with local radiotherapy (retroperitoneal + third lumbar vertebrae), the clinical effect is acceptable pain relief is acceptable, but CEA and CA19-9 ongoing rapidly increased. In March 12, 2009 ~3 23, the line of FOLFIRI a cycle chemotherapy (open Pu Tuo) appeared IV grade gastrointestinal reaction and IV level bone marrow suppression, tumor markers are still increasing, the highest rise to CEA 109.1, CA19-9 396.8. On May 11, 2009 start of nimotuzumab Tai Xinsheng (200mg / week, combined with chemotherapy of CF regimen for 6 weeks, tumor markers decreased to normal range, and quality of life in patients with the quality of life (QOL) score rose to normal; after single agent to maintain 1 month (weekly administration of 1), review, the curative effect is stable, because of economic reasons changed to every two weeks to drug 1 times, were used for a month, review the progress of the disease.
2 discussion
Colorectal cancer is one of the most common malignant tumors in human. The incidence of colorectal cancer is the third most common malignant tumor in the world. [1]. In 2006, the National Health Department statistics show that the mortality of colorectal cancer in China has ranked fifth [2], the incidence rate of colorectal cancer was 40 years old, and reached the peak at 60-75 years old. Incidence rate showed an increasing trend year by year [3]. Due to the development of genetics and molecular biology, the molecular basis of colorectal cancer has provided us with the most basic theoretical support. According to the current theory, the occurrence of colorectal cancer is largely due to the order of mutations accumulated in [4]. The core of the occurrence and development of colorectal cancer, which is the disorder of multiple independent signaling pathways, such as growth, apoptosis, differentiation and angiogenesis. Internal signaling pathways, such as growth factors, in which one or some of the factors may be over expressed or overexpressed. So, as a target for the role of drugs, compared to cancer cells and normal cells of the same onset of cytotoxic drugs lower toxicity, the prospect is more attractive, which is the so-called molecular targeted drugs. Colorectal cancer, tumor cells of about 25%-77% are expression of EGFR and in many treatment of colorectal cancer molecular target to drugs and epidermal growth factor receptor (epidermal growth factor receptor, EGFR targeting drugs attracted a lot of attention. EGFR signal transduction of error, will lead to the disorder of multiple signal transduction pathways, including cell proliferation, angiogenesis, invasion and metastasis, anti apoptosis, and resistance to chemotherapy or radiotherapy, leading to cancer occur [5]. At present, for the clinical use of EGFR divided into two categories: anti EGFR monoclonal antibodies and small molecule EGFR tyrosine kinase inhibitors (tyrosine kinase inhibitor, TKI), target to EGFR agents is a hot [6] in contemporary treatment of colorectal cancer. KRAS's role is to mediate extracellular ligand binding and intracellular signal transduction from EGFR to the nucleus, KRAS is a predictor of EGFR mutation is considered an indicator of the treatment of anti [7] antibody. Therefore, anti EGFR monoclonal antibody drugs should only be applied to the treatment of colorectal cancer in the wild type KRAS gene. At the same time, the level of EGFR expression will have a greater impact on the prognosis of anti EGFR monoclonal antibody drug therapy. Therefore, in theory should be recommended in the application of anti EGFR monoclonal antibodies in the treatment of colorectal cancer, the expression level of EGFR and KRAS gene mutations were detected.
The U.S. Food and Drug Administration (U. S. Food and Drug Administration (FDA) in 2004 approved cetuximab cetuximab (cetuximab, the name of the commodity, as love will be properly & reg;) for the treatment of colorectal cancer. Cetuximab single relatives of Anti Japan soldiers immunoglobulin G protein (IgG1) human mouse chimeric monoclonal antibody to competitive inhibition of binding of endogenous ligand and EGFR and blocking the downstream signal transduction pathway mediated by EGFR mediated ADCC and immune effect, lead to EGFR endocytosis and degradation. Rituximab and EGFR have a high affinity, a longer half-life, good tolerance, no hematological toxicity, do not increase the toxicity of the combined drug. Derek et [8] on 287 cases of colorectal cancer