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Zhang H, You J, Liu W, Chen D, Zhang S, Wang X. The efficacy and safety of bevacizumab combined with FOLFOX regimen in the treatment of advanced colorectal cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26714. [PMID: 34397704 PMCID: PMC8322501 DOI: 10.1097/md.0000000000026714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND It is necessary to systematically evaluate the clinical efficacy and safety of bevacizumab (BEV) combined with 5-fluorouracil + leucovorin + oxaliplatin (FOLFOX) regimen in the treatment of advanced colorectal cancer. METHODS We searched the PubMed et al databases for randomized controlled trials (RCTs) on the BEV combined with the FOLFOX regimen in the treatment of advanced colorectal cancer up to January 20, 2021. The Cochrane Collaborations' risk of bias tool was used for the quality assessment of included RCTs. Revman5.3 software was used for meta-analysis. RESULTS Eleven RCTs with a total of 3178 patients with advanced colorectal cancer were included, meta-analysis results showed that the objective response rate (odds ratio [OR] = 3.15, 95% confidence intervals [CI]: 2.25-4.40, P < .001) and cancer control rate (OR = 2.73, 95% CI: 1.91-3.90, P < .001) of BEV + FOLFOX were higher than that of FOLFOX group. And the incidence of gastrointestinal adverse reactions (OR = 1.29, 95% CI: 1.07-1.55, P = .008) in the BEV + FOLFOX group was higher than that of the FOLFOX group, there were no significant differences in the incidence of leukopenia (OR = 1.04, 95% CI: 0.72-1.50, P = .83), hypertension (OR = 3.92, 95% CI: 0.81-18.88, P = .09) and neurotoxicity (OR = 1.00, 95% CI: 0.8-1.27, P = .98) between the 2 groups. CONCLUSION BEV combined with the FOLFOX regimen is more effective than the FOLFOX regimen alone in the treatment of advanced colorectal cancer, but it may also increase the risk of gastrointestinal adverse reactions.
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Affiliation(s)
- Hailing Zhang
- Department of Gastroenterology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Jinzhi You
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Wei Liu
- Department of Gastroenterology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Dandan Chen
- Department of Gastroenterology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Shiqi Zhang
- Department of Gastroenterology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
| | - Xiaoyan Wang
- Department of Gastroenterology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China
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Puscasu A, Zanchetta M, Posocco B, Bunka D, Tartaggia S, Toffoli G. Development and validation of a selective SPR aptasensor for the detection of anticancer drug irinotecan in human plasma samples. Anal Bioanal Chem 2021; 413:1225-1236. [PMID: 33404749 DOI: 10.1007/s00216-020-03087-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
In this work, a surface plasmon resonance (SPR)-based assay for the quantification of antineoplastic drug irinotecan in human plasma samples has been developed for the first time. The selective binding of irinotecan with an aptamer receptor, operating in human plasma, allowed to set-up a novel analytical methodology to detect the drug in the analytical range of interest by using SPR as detection technique. After hybridizing the aptamer to the sensing platform and optimizing the sample preparation procedure, a quantitative assay was validated according to FDA regulatory guidelines. The analytical working range was found between 100 and 7500 ng mL-1 with negligible interferences from plasma components and co-medication associated with the administration of irinotecan. The utility of the new SPR assay was confirmed by analyzing plasma samples in parallel with LC-MS as reference technique, providing a new analytical tool for the therapeutic drug monitoring of irinotecan in patients under chemotherapy regimens.
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Affiliation(s)
- Adelina Puscasu
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy
| | - Martina Zanchetta
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy.,Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Giorgieri 1, 34127, Trieste, Italy
| | - Bianca Posocco
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy
| | - David Bunka
- Aptamer Group, Suite 2.78 - 2.91, Bio Centre, Innovation Way, Heslington, York, YO10 5NY, UK
| | - Stefano Tartaggia
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy.
| | - Giuseppe Toffoli
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy
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Dai J, Chen Y, Gong Y, Wei J, Cui X, Yu H, Zhao W, Gu D, Chen J. The efficacy and safety of irinotecan ± bevacizumab compared with oxaliplatin ± bevacizumab for metastatic colorectal cancer: A meta-analysis. Medicine (Baltimore) 2019; 98:e17384. [PMID: 31574891 PMCID: PMC6775432 DOI: 10.1097/md.0000000000017384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Irinotecan (IRI)-based and oxaliplatin (OXA)-based regimens are available for the treatment of metastatic colorectal cancer (mCRC). Several studies have published inconsistent results in their comparisons of the efficacy and toxicity of IRI ± bevacizumab and OXA ± bevacizumab. This meta-analysis was performed to evaluate the efficacy and safety of these 2 regimens in patients with mCRC. METHODS We searched several databases to identify relevant studies, including PubMed, EMBASE, and the Cochrane Controlled Trials Register. The primary endpoints were overall survival (OS) and time to progression (TTP). The secondary comparisons were overall response rate (ORR) and toxicity. In addition, the hazard ratio (HR) or risk ratio (RR) values with their corresponding 95% confidence intervals (CIs) were extracted from these studies. RESULTS Pooled data of 13 studies demonstrated no significant differences in OS (HR = 0.96, 95% CI: 0.86-1.08, P = .53) and TTP (HR = 0.88, 95% CI: 0.72-1.08, P = .24) between the 2 groups. However, the ORR (RR = 0.87, 95% CI: 0.78-0.97, P = .02) was clearly improved in the OXA ± bevacizumab arm. Higher incidences of grade 3/4 nausea (RR = 1.63, 95% CI: 1.28-2.07, P < .001), vomiting (RR = 1.40, 95% CI: 1.09-1.81, P = .01), diarrhea (RR = 1.44, 95% CI: 1.23-1.70, P < .001), and anemia (RR = 4.13, 95% CI: 2.75-6.22, P < .001) were observed in the IRI group. However, the incidences of grade 3/4 neutropenia (RR = 0.75, 95% CI: 0.68-0.83, P < .001), thrombocytopenia (RR = 0.43, 95% CI: 0.26-0.73, P = .002), and paresthesia/neurological disturbances (RR = 0.04, 95% CI: 0.02-0.07, P < .001) were higher in the OXA group. CONCLUSION This meta-analysis confirmed that the OXA ± bevacizumab regimen as a maintenance therapy significantly improved the ORR in patients with mCRC. Exhibiting strong efficacy and safety, the OXA and OXA plus bevacizumab regimens are preferred as first-line treatments for mCRC.
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Affiliation(s)
- Jiali Dai
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Yuetong Chen
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Yang Gong
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Jingsun Wei
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Xiaowen Cui
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Hualin Yu
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Wenjing Zhao
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Dongying Gu
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
| | - Jinfei Chen
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University
- Cancer Center, Taikang Xianlin Drum Tower Hospital, Nanjing University
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
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Xu R, Xu C, Liu C, Cui C, Zhu J. Efficacy and safety of bevacizumab-based combination therapy for treatment of patients with metastatic colorectal cancer. Onco Targets Ther 2018; 11:8605-8621. [PMID: 30584320 PMCID: PMC6287670 DOI: 10.2147/ott.s171724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aim The use of bevacizumab in combination therapy is an emerging trend in metastatic colorectal cancer treatment. However, the clinical value of different combination types remains under debate. Thus, a meta-analysis of randomized controlled trials (RCTs) comparing bevacizumab-based combination therapy with monotherapy (therapy that uses one type of treatment, such as chemotherapy or surgery alone, to treat metastatic colorectal cancer) was performed, aiming to evaluate the safety and efficacy of bevacizumab-based combination therapy and to find a more beneficial combination. Methods We searched for clinical studies that evaluated bevacizumab-based combination therapy in metastatic colorectal cancer. We extracted data from these studies to evaluate the relative risk (RR) of overall response rate (ORR) and grade 3/4 treatment-related adverse events (AEs), HRs of overall survival (OS), and progression-free survival (PFS). Results Eight RCTs were identified (n=3,424). Treatments included combinations of bevacizumab and oxaliplatin, fluorouracil, and leucovorin (FOLFOX4), combinations of bevacizumab and capecitabine and oxaliplatin, combinations of bevacizumab and fluorouracil/leucovorin, combinations of bevacizumab and irinotecan, fluorouracil, and leucovorin (IFL), and combinations of bevacizumab and capecitabine. Bevacizumab-based combination therapy showed higher ORR (RR: 1.40; 95% CI: 1.10-1.78; P=0.005), PFS (HR: 0.64; 95% CI: 0.55-0.73; P=0.000), and OS (HR: 0.82; 95% CI: 0.73-0.92; P=0.001) values than monotherapy. However, higher grade 3/4 treatment-related AEs (RR: 1.27; 95% CI: 1.15-1.41; P=0.000) were observed in combination therapy than in monotherapy. Conclusion This meta-analysis showed that the addition of IFL to bevacizumab better benefits PFS and safety. Adding FOLFOX4 was associated with better ORR and OS. The efficacy and safety of an IFL-bevacizumab-FOLFOX4 combination should be given greater weight in future clinical trials, guidelines, and clinical practice.
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Affiliation(s)
- Ran Xu
- Medical School of Nantong University, Jiangsu 226001, China, .,Huai'an Key Laboratory of Gastrointestinal Cancer, Jiangsu 223001, China,
| | - Chen Xu
- Medical School of Nantong University, Jiangsu 226001, China,
| | - Chuntong Liu
- XuZhou Medical University, Jiangsu 221000, China
| | - Can Cui
- Macau University of Science and Technology, Macau 519020, China
| | - Jing Zhu
- Department of Oncology, The Affiliated Huaian NO 1 People's Hospital of Nanjing Medical University, Jiangsu 223001, China,
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Tartaggia S, Alvau MD, Meneghello A, Casetta B, Polo F, Toffoli G. Practical fluorimetric assay for the detection of anticancer drug SN-38 in human plasma. J Pharm Biomed Anal 2018; 159:73-81. [PMID: 29980022 DOI: 10.1016/j.jpba.2018.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 11/19/2022]
Abstract
The implementation of therapeutic drug monitoring in the routine clinical practice in oncology is mainly limited by the lack of therapeutic indexes for the majority of the anticancer drugs, and by the absence of suitable analytical tools, which can accurately quantify in real time the concentration of the administered drugs and their relevant metabolites in biological fluids. In this work, a simple and efficient fluorimetric determination of SN-38, the active metabolite of the anticancer drug irinotecan, was developed and applied to human plasma samples. The intrinsic fluorescence of SN-38 allowed its quantification in the range 10-500 ng mL-1 with a LOQ of 5.0 ng mL-1 and a LOD of 1.5 ng mL-1. Low interferences due to main metabolites of irinotecan and comedications, commonly associated with administration of irinotecan, were observed. A validation study, according to FDA and EMA guidelines for bioanalytical method validation, was carried out and, finally, blind samples were analyzed in parallel with a HPLC-MS method obtaining an excellent agreement between the two techniques.
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Affiliation(s)
- Stefano Tartaggia
- Experimental and Clinical Pharmacology Unit, National Cancer Institute - Centro di Riferimento Oncologico, Via Franco Gallini 2, I-33081, Aviano, Italy.
| | - Maria Domenica Alvau
- Experimental and Clinical Pharmacology Unit, National Cancer Institute - Centro di Riferimento Oncologico, Via Franco Gallini 2, I-33081, Aviano, Italy
| | - Anna Meneghello
- Experimental and Clinical Pharmacology Unit, National Cancer Institute - Centro di Riferimento Oncologico, Via Franco Gallini 2, I-33081, Aviano, Italy
| | - Bruno Casetta
- Experimental and Clinical Pharmacology Unit, National Cancer Institute - Centro di Riferimento Oncologico, Via Franco Gallini 2, I-33081, Aviano, Italy
| | - Federico Polo
- Experimental and Clinical Pharmacology Unit, National Cancer Institute - Centro di Riferimento Oncologico, Via Franco Gallini 2, I-33081, Aviano, Italy.
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, National Cancer Institute - Centro di Riferimento Oncologico, Via Franco Gallini 2, I-33081, Aviano, Italy
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