切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (03) : 305 -309. doi: 10.3877/cma.j.issn.2095-3224.2020.03.019

所属专题: 经典病例 经典病例 文献

病例报道

BRAF抑制剂联合抗EGFR单抗和伊立替康解救治疗BRAF V600E突变的转移性结肠癌一例报告并文献复习
彭黎明1, 王静2, 杨林1,()   
  1. 1. 100021 北京市,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肿瘤内科
    2. 100021 北京市朝阳区三环肿瘤医院肿瘤科
  • 收稿日期:2019-10-21 出版日期:2020-06-25
  • 通信作者: 杨林

A case report of BRAF inhibitor combined with anti-EGFR monoclonal antibody and irinotecan in the treatment of metastatic colon cancer with BRAF V600E mutation and literature review

Liming Peng1, Jing Wang2, Lin Yang1,()   

  1. 1. Department of Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    2. Department of Oncology, Sanhuan Cancer Hospital, Beijing 100021, China
  • Received:2019-10-21 Published:2020-06-25
  • Corresponding author: Lin Yang
  • About author:
    Corresponding author: Yang Lin, Email:
引用本文:

彭黎明, 王静, 杨林. BRAF抑制剂联合抗EGFR单抗和伊立替康解救治疗BRAF V600E突变的转移性结肠癌一例报告并文献复习[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(03): 305-309.

Liming Peng, Jing Wang, Lin Yang. A case report of BRAF inhibitor combined with anti-EGFR monoclonal antibody and irinotecan in the treatment of metastatic colon cancer with BRAF V600E mutation and literature review[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(03): 305-309.

BRAF基因是RAF激酶家族的一员,约14%的原发性结直肠癌和8%转移性结直肠癌(mCRC)患者发生BRAF突变。BRAF V600E,作为BRAF突变mCRC最常见的类型,常规治疗效果差,疾病进展快、生存期短、预后差。中国医学科学院肿瘤医院收治一例BRAF V600E突变晚期结肠癌患者,二线化疗+靶向治疗肿瘤均无明显缩小,三线BRAF抑制剂联合化疗及靶向治疗取得部分缓解(PR),现报告如下。

The BRAF gene is a member of the RAF kinase family, and BRAF mutations occur in approximately 14% of patients with primary CRC and 8% mCRC. BRAF V600E CRC, as the most common type of BRAF mutation mCRC, has poor conventional treatment efficacy, rapid disease progression, short survival, and poor prognosis. In Cancer Hospital, Chinese Academy of Medical Sciences, we received an advanced colon cancer patient with BRAF V600E mutation. Two-line therapy with chemotherapy and targeted therapy showed no significant tumor reduction. The third-line therapy, BRAF inhibitor combined with chemotherapy and targeted therapy, achieved PR (partial response). The report is as follows.

图1 治疗过程中肿瘤标记物变化情况
图2 腹部增强CT。2A:一线基线;2B:二线基线;2C:三线基线;2D:三线最佳疗效;2E:三线进展
图3 腹部、盆腔CT。3A、3B、3C为肿瘤终末期
[1]
Jemal A, Bray F, Center MM, et al. Global cancer statistics [J]. CA: A Cancer Journal for Clinicians, 2011, 61(2): 69-90.
[2]
Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017 [J]. CA: A Cancer Journal for Clinicians, 2017, 67(3): 177-193.
[3]
Sepulveda AR, Hamilton SR, Allegra CJ, et al. Molecular biomarkers for the evaluation of colorectal cancer: guideline summary from the American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology, and American Society of Clinical Oncology [J]. Journal of Oncology Practice, 2017, 13(5): 333-337.
[4]
Loree JM, Pereira AAL, Lam M, et al. Classifying colorectal cancer by tumor location rather than sidedness highlights a continuum in mutation profiles and consensus molecular subtypes [J]. Clin Cancer Res, 2018, 24(5): 1062-1072.
[5]
Clarke CN, Kopetz ES. BRAF mutant colorectal cancer as a distinct subset of colorectal cancer: clinical characteristics, clinical behavior, and response to targeted therapies [J]. Journal of Gastrointestinal Oncology, 2015, 6(6): 660-667.
[6]
Souglakos J, Philips J, Wang R, et al. Prognostic and predictive value of common mutations for treatment response and survival in patients with metastatic colorectal cancer [J]. British Journal of Cancer, 2009, 101(3): 465-472.
[7]
Salem ME, Weinberg BA, Xiu J, et al. Comparative molecular analyses of left-sided colon, right-sided colon, and rectal cancers [J]. Oncotarget, 2017, 8(49): 86356-86368.
[8]
Tie J, Gibbs P, Lipton L, et al. Optimizing targeted therapeutic development: analysis of a colorectal cancer patient population with the BRAF(V600E) mutation [J]. International Journal of Cancer, 2011, 128(9): 2075-2084.
[9]
Wang X, Wei Q, Gao J, et al. Clinicopathologic features and treatment efficacy of Chinese patients with BRAF-mutated metastatic colorectal cancer: a retrospective observational study [J]. Chinese Journal of Cancer, 2017, 36(1): 81.
[10]
Chen D, Huang JF, Liu K, et al. BRAFV600E mutation and its association with clinicopathological features of colorectal cancer: a systematic review and meta-analysis [J]. PloS One, 2014, 9(3): e90607.
[11]
Samowitz WS, Sweeney C, Herrick J, et al. Poor survival associated with the BRAF V600E mutation in microsatellite-stable colon cancers [J]. Cancer Research, 2005, 65(14): 6063-6069.
[12]
Xu Q, Xu AT, Zhu MM, et al. Predictive and prognostic roles of BRAF mutation in patients with metastatic colorectal cancer treated with anti-epidermal growth factor receptor monoclonal antibodies: a meta-analysis [J]. Journal of Digestive Diseases, 2013, 14(8): 409-416.
[13]
Sinicrope FA, Shi Q, Allegra CJ, et al. Association of DNA mismatch repair and mutations in BRAF and KRAS with survival after recurrence in stage III colon cancers : A secondary analysis of 2 randomized clinical trials [J]. JAMA Oncology, 2017, 3(4): 472-480.
[14]
De Roock W, Claes B, Bernasconi D, et al. Effects of KRAS, BRAF, NRAS, and PIK3CA mutations on the efficacy of cetuximab plus chemotherapy in chemotherapy-refractory metastatic colorectal cancer: a retrospective consortium analysis [J]. The Lancet Oncology, 2010, 11(8): 753-762.
[15]
Cremolini C, Loupakis F, Masi G, et al. FOLFOXIRI or FOLFOXIRI plus bevacizumab as first-line treatment of metastatic colorectal cancer: a propensity score-adjusted analysis from two randomized clinical trials [J]. Annals of Oncology : Official Journal of the European Society for Medical Oncology, 2016, 27(5): 843-849.
[16]
Cremolini C, Loupakis F, Antoniotti C, et al. FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study [J]. The Lancet Oncology, 2015, 16(13): 1306-1315.
[17]
Pietrantonio F, Petrelli F, Coinu A, et al. Predictive role of BRAF mutations in patients with advanced colorectal cancer receiving cetuximab and panitumumab: a meta-analysis [J]. European Journal of Cancer (Oxford, England : 1990), 2015, 51(5): 587-594.
[18]
Rowland A, Dias MM, Wiese MD, et al. Meta-analysis of BRAF mutation as a predictive biomarker of benefit from anti-EGFR monoclonal antibody therapy for RAS wild-type metastatic colorectal cancer [J]. British Journal of Cancer, 2015, 112(12): 1888-1894.
[19]
Kopetz S, Mcdonough SL, Morris VK, et al. Randomized trial of irinotecan and cetuximab with or without vemurafenib in BRAF-mutant metastatic colorectal cancer (SWOG 1406) [J]. J Clin Oncol, 2017, 35(4_suppl): 520.
[20]
Elez E, Argiles G, Tabernero J. First-line treatment of metastatic colorectal cancer: Interpreting FIRE-3, PEAK, and CALGB/SWOG 80405 [J]. Current Treatment Options in Oncology, 2015, 16(11): 52.
[21]
Kopetz S, Desai J, Chan E, et al. Phase II pilot study of vemurafenib in patients with metastatic BRAF-mutated colorectal cancer [J]. J Clin Oncol, 2015, 33(34): 4032-4038.
[22]
Prahallad A, Sun C, Huang S, et al. Unresponsiveness of colon cancer to BRAF(V600E) inhibition through feedback activation of EGFR [J]. Nature, 2012, 483(7387): 100-103.
[23]
Yang H, Higgins B, Kolinsky K, et al. Antitumor activity of BRAF inhibitor vemurafenib in preclinical models of BRAF-mutant colorectal cancer [J]. Cancer Research, 2012, 72(3): 779-789.
[24]
Corcoran RB, Ebi H, Turke AB, et al. EGFR-mediated re-activation of MAPK signaling contributes to insensitivity of BRAF mutant colorectal cancers to RAF inhibition with vemurafenib [J]. Cancer Discovery, 2012, 2(3): 227-235.
[25]
Atreya CE, Van Cutsem E, Bendell JC, et al. Updated efficacy of the MEK inhibitor trametinib (T), BRAF inhibitor dabrafenib (D), and anti-EGFR antibody panitumumab (P) in patients (pts) with BRAF V600E mutated (BRAFm) metastatic colorectal cancer (mCRC). J Clin oncol, 2015, 33(suppl): a103.
[26]
Pan JH, Zhou H, Zhu SB, et al. Development of small-molecule therapeutics and strategies for targeting RAF kinase in BRAF-mutant colorectal cancer [J]. Cancer Management and Research, 2018, 10(2): 289-301.
[27]
Wang Z, Dai WP, Zang YS. Complete response with fluorouracil and irinotecan with a BRAF(V600E) and EGFR inhibitor in BRAF-mutated metastatic colorectal cancer: a case report [J]. OncoTargets and Therapy, 2019, 12: 443-447.
[28]
Van Cutsem E, Huijberts S, Grothey A, et al. Binimetinib, Encorafenib, and Cetuximab Triplet therapy for patients with BRAF V600E-Mutant metastatic colorectal cancer: safety lead-in results from the phase III BEACON colorectal cancer study [J]. J Clin Oncol, 2019, 37(17): 1460-1469.
[1] 王若岩, 贾琳娇, 孔舒欣, 范盼红, 王磊, 李文涛. 原发性肺癌乳腺转移一例[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(04): 248-250.
[2] 铁晓玲, 刘毅, 杨颖, 车凤玉. Rubinstein-Taybi综合征先证者3例并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 452-459.
[3] 崔宏帅, 冯丽明, 东维玲, 韩博. 腹腔镜右半结肠癌D3根治术+IGLN清扫术治疗局部进展期结肠肝曲癌的临床效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 566-569.
[4] 丁志翔, 于鹏, 段绍斌. 血浆BRAF基因检测对腹腔镜右半结肠癌D3根治术中行幽门淋巴结清扫的指导价值[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 570-573.
[5] 王维花, 王楠, 乔庆, 罗红. 完全腹腔镜右半结肠癌切除术两种腔内消化道重建方案对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 574-577.
[6] 黄莹, 李璇, 刘梦杨, 彭桂林, 徐鑫, 韦兵, 杨超. 靶向联合治疗双肺移植术后KRAS和BRAF基因双突变晚期肺腺癌一例[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 298-301.
[7] 赖淼, 景鑫, 李桂珍, 李怡. 非小细胞肺癌EGFR 突变亚型的临床病理和预后意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 731-737.
[8] 刘文竹, 唐窈, 刘付臣. 诱导多潜能干细胞在神经肌肉疾病研究中的应用进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(06): 367-373.
[9] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[10] 何慧玲, 鲁祖斌, 冯嘉莉, 梁声强. 术前外周血NLR和PLR对结肠癌术后肝转移的影响[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 682-687.
[11] 关国欣, 罗福文. 结肠癌合并急性梗阻的个性化处理[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 459-463.
[12] 石阳, 于剑锋, 曹可, 翟志伟, 叶春祥, 王振军, 韩加刚. 可扩张金属支架置入联合新辅助化疗治疗完全梗阻性左半结肠癌围手术期并发症分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 464-471.
[13] 惠泉, 孙方昱, 赵欣, 许青, 李奕, 陈建雄, 吴立, 郑伟燕. 急性间歇性卟啉病HMBS基因新发缺失突变一例[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 507-511.
[14] 李玺, 蔡芸莹, 张永红, 苏恒. 假性软骨发育不全合并1型糖尿病一例[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 518-520.
[15] 靳英, 付小霞, 陈美茹, 袁璐, 郝力瑶. CD147调控MAPK信号通路对结肠癌细胞增殖和凋亡的影响及机制研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 474-480.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?