CHOOSING CHEMOTHERAPEUTIC TREATMENT USING THE SENSITIVITY MARKERS IN PATIENTS WITH COLORECTAL CANCER
Keywords:
colorectal cancer, chemotherapy, progression, markers.Abstract
Summary. Previously, in the retrospective study, we
determined the prognostic value of the antigen panel
(topoisomerase II-alpha (Topo II-α), ERCC1, E-cadherin) in the choice of chemotherapy (CT) in colorectal cancer (CRC) patients. Aim: to compare the efficacy of CT FOLFOX-6 or FOLFIRI regimens in patients with CRC, taking into account the expression
in the material of primary tumors of E-cadherin,
ERCC1, Topo II-α. Object and methods: clinical data
of 85 patients with primary CRC (T2–4N0–2M0) received complex treatment according to modern standards: 53 patients — the main group, 32 — control.
The choice of the CT scheme in the main group was
carried out taking into account the immunohistochemical determination of E-cadherin, Topo II-α,
ERCC1. Patients with low ERCC1 expression in combination with high E-cadherin expression, regardless
of Topo II-α expression, or low expression of E-cadherin and Topo II-α, were treated according to the
FOLFOX-6 regimen, the rest according to the scheme
FOLFIRI. In the control group, the expression of these
markers was not determined, all patients received adjuvant CT in the FOLFOX-6 regimen. Results: using
the algorithm for selecting CT regimens based on the
expression of ERCC1, Topo II-α and E-cadherin markers, it was possible to reliably increase the incidence
of recurrence-free disease (66.0% in the main group vs
53.1% in the control; p = 0.046). With a low expression of the ERCC1, Topo II-α and high E-cadherin
markers, a favorable prognosis after complex treatment
with the FOLFOX-6 regimen was noted. In patients
with predominantly high ERCC1 expression, with different combinations of E-cadherin and Topo II-α levels, the prognosis is less favorable, and the FOLFIRI
scheme is justified in such patients. Conclusion: the obtained data allow to purposefully correct the medication
of CRC patients after surgical intervention.
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