Analysis of the real-world treatment status of treatment of BRAF mutations in advanced colorectal cancer in the real world
Objective To explore the clinical application and efficacy of advanced colorectal cancer with V-raf murine sarco-ma viral oncogene homolog(BRAF)gene mutations in the real world.Methods Retrospective analysis was conducted on the clinical data of 60 patients with advanced colorectal cancer diagnosed with BRAF-mutation who attended Henan Pro-vincial Cancer Hospital from September 1,2019,to December 30,2021.The included patients.based on medication,were divided into a 3-agent combination chemotherapy group[n=9;FOLFOXIRI(fluorouracil/calcium folinic acid,oxaliplatin,and irinotecan hydrochloride)+bevacizumab],a 2-agent combination chemotherapy group[n=48;2-agent chemotherapy regimen based on fluorouracil analogs in combination with oxaliplatin or irinotecan hydrochloride+bevacizumab],and an immunotherapy group[n=3;patients using programmed death receptor 1(PD-1)].Forty-two patients(70.00％)entered the second-line treatment with cetuximab+BRAF inhibitor+MEK inhibitor(targeted group,n=19)or irinotecan hydrochloride+fluorouracil+bevacizumab(chemotherapy group,n=23).Count data were expressed as n(％),and the x2 test or Fisher's exact method was used to compare the efficacy of different treatment options in each line.Survival analy-sis was performed using the Kaplan-Meier method,Log-rank test was used to compare the differences between groups,and multivariate Cox proportional hazards regression analysis was performed to explore the prognostic factors.Results The objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),and overall survival(OS)were 22.22％vs 8.33％(x2=0.428,P=0.513),66.67％vs 52.08％(x2=0.195,P=0.659),9.50 months vs 6.50 months(x2=8.087,P=0.005),15.83 months vs 11.07 months(x=0.523,P=0.470)for the 3-agent combination chemotherapy group and 2-agent combination chemotherapy group,respectively.The ORR,DCR,PFS,OS of the 2 groups were 21.10％vs 8.70％(x2=1.302,P=0.384),63.20％vs 30.43％(x2=4.500,P=0.034),5.73 months vs 4.07 months(x2=8.833,P=0.003),6.33 months vs 5.30 months(x2=0.796,P=0.372)for the targeted and chemotherapy groups defined by this model,respectively.Multifactorial Cox regression analysis showed that gender,degree of differentia-tion and distant lymph node metastasis were independent factors for OS(P＜0.05).Conclusion In the first-line treat-ment of advanced colorectal with BRAF mutation,fluorouracil combined with oxaliplatin or irinotecan is an alternative treatment option for those who cannot tolerate FOLFOXIRI;Cetuximab+BRAF inhibitor+MEK inhibitor is more ef-fective in the second-line treatment.
colorectal cancerBRAF mutationefficacyprognosisreal-world study
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