A Retrospective Study On The Efficacy And Safety Of Bevacizumab Combined With Chemotherapy And Traditional Chinese Medicine For Advanced Colorectal Cancer

Background:Colorectal cancer is a common malignant tumor of the digestive tract,the incidence rate is the third highest in China.Since there is no national colorectal cancer screening program in China,some patients with colorectal cancer have already metastasized at the time of treatment.At present,mCRC usually adopts chemotherapy-based comprehensive treatment programs,such as FOLFOX,FOLFIRI,etc.Bevacizumab is a recombinant humanized monoclonal antibody against VEGF,which can improve the effective rate of mCRC and prolong the survival time combined with chemotherapy.The purpose of this study was to analyze the short-term efficacy,long-term efficacy,and safety of bevacizumab combined with chemotherapy in patients with mCRC,in order to fully evaluate and select appropriate patients in clinical applications,balance bevacizumab's anti-tumor efficacy and possible risk of adverse reactions combined with chemotherapy,complete monitoring and prevention,so that bevacizumab can bring better survival benefits to patients.Method:This study was designed to use a non-controlled,non-randomized,retrospective study to collect patients with mCRC who use the treatment of bevacizumab combined with chemotherapy and traditional Chinese medicine from January 2013-August 2018 in the oncology department of China-Japan Friendship Hospita1.86 patients were eventually enrolled.To analyze the short-term efficacy,long-term efficacy and safety of patients,and to perform single-factor stratified analysis to compare different genders,ages,ECOG scores,primary tumor sites,degree of pathological differentiation,radical surgery or not,tumor metastasis sites,number of metastases,chemotherapy regimens,chemotherapy lines,and whether or not bevacizumab maintenance therapy was used.The incidence and severity of adverse reactions and the prevention and treatment of traditional Chinese medicine during the treatment with bevacizumab combined with chemotherapy.Multivariate analysis the independent prognostic factors of bevacizumab combined with chemotherapy in the treatment of mCRC.Result:A total of 86 patients were enrolled,all with imaging evaluable target lesions.There were 41 cases of metastatic colon cancer,45 cases of metastatic rectal cancer,47 cases of first-line treatment,30 cases of second-line treatment,9 cases of third-line treatment,34 cases of chemotherapy combined with mFOLFOX6,35 cases of chemotherapy combined with FOLFIRI,9 cases of chemotherapy with XELOX,8 cases of chemotherapy combined with capecitabine.The overall RR was 30.2%and DCR was 84.9%.There was no significant difference in RR and DCR between different chemotherapy regimens,primary tumor sites and chemotherapy lines(P>0.05).The mPFS was 9.80 months in the entire group.There were no significant differences in mPFS between genders,ages,chemotherapy regimens,chemotherapy lines,radical surgery or not,primary tumor sites,degree of pathological differentiation,metastatic sites,and number of metastases(P>0.05).There was a statistically significant difference in mPFS between the ECOG scores and whether or not to receive bevacizumab maintenance therapy(P<0.05).The mPFS with ECOG score of 0-1 was 11.23 months,the mPFS of 2-3 was 7.23 months,and the mPFS of patients receiving bevacizumab maintenance therapy was 22.13 months,and the mPFS of the unreceiver was 8.40 months.Multivariate analysis showed that ECOG scores and maintenance of bevacizumab were independent factors in the prohression of the disease(P<0.05).The mOS was 19.1 months in the entire group.There was no significant difference in mOS between genders,ages,chemotherapy regimens,number of chemotherapy lines,radical surgery or not,primary tumor sites,metastatic sites,and number of metastases(P>0.05).There was a statistically significant difference in mOS between ECOG scores,degree of pathological differentiation,and whether or not to receive bevacizumab maintenance therapy(P<0.05).The mOS with ECOG score of 0-1 was 22.2 months,and the mOS of 2-3 was 11.7months.The higher the degree of differentiation,the longer mOS;the mOS of patients receiving bevacizumab maintenance therapy was not shown,the mOS of the unreceiver was 17.3 months.Multivariate analysis showed that ECOG scores,degree of pathological differentiation were the main independent prognostic factors(P<0.05).The main adverse reactions of chemotherapy in 86 patients were:nausea(36.0%),neutropenia(34.9%),hemoglobin reduction(32.6%),fatigue(31.4%),white blood cells reduction(29.1%),thrombocytopenia(27.9%),peripheral neurotoxicity(23.3%),vomit(19.8%),etc.Among them,grade 3 and 4 adverse reactions mainly include:neutropenia(10.5%),thrombocytopenia(7.0%),white blood cells reduction(7.0%)and hemoglobin reduction(3.5%).There were no adverse events in grade 5 leading to death in this study.Bevacizumab related adverse reactions were:hypertension(19.8%),hemorrhage(16.3%),proteinuria(10.5%),sigmoid colon perforation(2.3%),lower extremity venous thrombosis(1.2%).All the above patients were treated with traditional Chinese medicine,traditional Chinese medicine combined with western medicine or surgery,all the adverse reactions were alleviated.Conclusion:This study demonstrates that bevacizumab combined with chemotherapy has good short-term efficacy and long-term efficacy,and high safety.Traditional Chinese medicine has good effects in preventing and treating related adverse reactions and can bring better survival benefits to patients.