FDA批准的结肠癌用药（10/28/2009）

Colon Cancer

Chemotherapy

Chemotherapy Drugs and Regimens

Seven drugs are currently approved for colorectal cancer chemotherapy:

• 5-fluorouracil (5-FU, Adrucil), which is often given in combination with leucovorin (Wellcovorin). Leucovorin is a vitamin that helps boost the effectiveness of 5-FU.
• Capecitabine (Xeloda)
• Oxaliplatin (Eloxatin)
• Irinotecan (Camptosar)
• Bevacizumab (Avastin)
• Cetuximab (Erbitux)
• Panitumumab (Vectibix)

Capecitabine is a pill form of 5-FU. The other drugs are administered intravenously. Many of these drugs are given in combination with each other. Common chemotherapy combination regimens include:

• 5-FU / LV (5-FU and leucovorin)
• FOLFOX (5-FU with leucovorin and oxaliplatin)
• FOLFORI (5-FU with leucovorin and irinotecan)
• IFL (Irinotecan, 5-FU, leucovorin)
• XELOX (Capecitabine and oxaliplatin)

Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment. Because cancer cells grow and divide rapidly, chemotherapy drugs work by killing fast-growing cells. This means that healthy cells that multiply quickly can also be affected. The fast-growing normal cells most likely to be affected are blood cells forming in the bone marrow, and cells in the digestive tract, reproductive system, and hair follicles. Nausea and vomiting is a very common side effect, but drugs such as ondansetron (Zofran) can help provide relief. In general, side effects are nearly always temporary, and medications can help manage them. Most patients are able to continue with normal activities for all but perhaps 1 - 2 days a month.

Specific Chemotherapy Drugs

5-Fluorouracil (5-FU) with Leucovorin. Adjuvant (following surgery) chemotherapy using 5-fluorouracil, either alone or with leucovorin (5-FU/LV), is the standard treatment for patients with high-risk colon cancer (Stage III or select patients with Stage II tumors). Leucovorin, also called folinic acid, is a form of the B vitamin folic acid, which helps increase 5-FU’s effectiveness. Patients are given a series of cycles that usually continue for at least 6 months.
There are many different ways of giving 5-FU, including intravenously over several hours once a week, intravenously daily for 5 consecutive days every month, or as continuous infusion with a portable pump. The most common side effects include nausea and vomiting, diarrhea, loss of appetite, hair loss, swelling of hands and feet, rashes, and mouth sores.
Irinotecan. Irinotecan (Camptosar) blocks an enzyme essential for cell division. Irinotecan can be given alone or in combination with 5-FU and leucovorin. This combination therapy (irinotecan plus 5-FU/LV) is also referred to as the "Salz regimen," or IFL. Diarrhea is a common side effect of irinotecan.
Capecitabine. Capecitabine (Xeloda), an oral form of 5-FU, is used as a treatment for stage III and stage IV (metastatic) colorectal cancer. It is the only pill approved for colorectal cancer. Oxaliplatin. Oxaliplatin (Eloxatin) is related to cisplatin, a widely used platinum-based chemotherapy drug. Oxaliplatin is used in combination with 5-FU and leucovorin. This triple combination therapy is called the FOLFOX regimen.
Oxaliplatin. Oxaliplatin (Eloxatin) is related to cisplatin, a widely used platinum-based chemotherapy drug. Oxaliplatin is used in combination with 5-FU and leucovorin. (This triple combination therapy is called the FOLFOX regimen.) Oxaliplatin can cause pain and tingling sensations in the hands and feet (neuropathy) that is worsened by exposure to cold.
Bevacizumab. Bevacizumab (Avastin) was approved in 2004 as a first-line treatment for patients with metastatic colorectal cancer (advanced cancer that has spread in the body). It is used in combination with IFL (irinotecan, 5-FU, leucovorin). Bevacizumab is a biologic drug. It is a genetically engineered monoclonal antibody that targets and inhibits vascular endothelial growth factor (VEGF), a protein that regulates angiogenesis (the development of new blood vessels that feed a tumor's blood supply). It is the first anti-angiogenic therapy approved for the treatment of colorectal cancer.
Studies indicate that bevacizumab administered intravenously along with IFL extends survival by about 5 months longer than IFL alone. Common side effects of bevacizumab include nosebleeds, fatigue, diarrhea, and high blood pressure. Less common side effects include stroke, heart attacks, angina, and formation of holes in the colon and stomach (gastrointestinal perforation).
Cetuximab. Cetuximab (Erbitux) was approved in 2004 for the treatment of metastatic colorectal cancer. This monoclonal antibody drug targets epidermal growth factor receptor (EGFR), a protein required by cancer cells in order to proliferate. It can be used either in combination with irinotecan or alone for patients who have not responded to irinotecan. Studies of the cetuximab-irinotecan combination suggest it can help in tumor shrinkage. It has a modest effect on survival, prolonging patients' lives by about an additional month or two. Recent guidelines recommend that cetuximab, and panitumumab (see below), should be given only to patients with tumors that express the wild-type KRAS gene. Patients with metastatic cancer should have tumors tested for KRAS gene status.
Panitumumab . Panitumumab (Vectibix) was approved in 2006 for treatment of colorectal cancer that has metastasized following standard chemotherapy. Like cetuximab, panitumumab is a monoclonal antibody drug that targets EGFR. In clinical trials, panitumumab helped delay disease progression and prolong survival by about 3 months. About 8% of patients experienced tumor shrinkage. Common side effects of this drug include skin rash, fatigue, abdominal pain, nausea, and diarrhea or constipation. Serious side effects include pulmonary fibrosis, severe skin rash, and skin reactions at the infusion site.

Investigational Biologic Drugs

One of the most promising recent developments in cancer treatment research has been the emergence of so-called "targeted therapies." Traditional chemotherapy drugs can be effective, but because they do not distinguish between healthy and cancerous cells their generalized toxicity can cause severe side effects. Targeted therapies work on a molecular level by blocking specific mechanisms associated with cancer cell growth and division.
Many targeted therapies are classified as biologic drugs. Bevacizumab (Avastin), cetixumab (Erbitux), and panitumumab (Vectibix) are currently the three biologic drugs approved for colorectal cancer treatment, but other drugs are in development.
Targeted therapies involve many different types of drugs and molecular pathways. These include:
Angiogenesis Inhibitors. Anti-angiogenesis drugs inhibit the formation of new blood vessels that supply tumors with the blood, oxygen, and nutrients vital to tumor growth. Angiogenesis inhibitors, such as the monoclonal antibody bevacizumab (Avastin), target vascular endothelial growth factor (VEGF). Cediranib (Recentin), formerly AZD2171, is a new angiogenesis inhibitor that is in Phase III clinical trials for treatment of colorectal cancer.
Tumor Growth Factor Inhibitors. Tumor growth factors, such as epidermal growth factor, stimulate cell growth. Cetixumab (Erbitux) and panitumumab (Vectibix) are the two currently approved colorectal cancer drugs that target the epidermal growth factor receptor (EGFR). Nimotuzumab (TheraCIM) is currently being studied in combination with irinotecan.
Tyrosine Kinase Inhibitors. Tyrosine kinase is an enzyme associated with EGFR that is involved with the signaling mechanisms that prompt cell growth. The EGFR/tyrosine kinase inhibitor erlotinib (Tarceva), which is approved for the treatment of pancreatic and lung cancers, is being investigated as an adjuvant treatment for metastatic colorectal cancer. Sunitinib (Sutent), which is approved for renal cell carcinoma, is another tyrosine kinase inhibitor in trials for colorectal cancer.

Review Date: 10/28/2009
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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不可切除的结直肠癌肝转移的综合治疗

结直肠癌肝转移诊断和综合治疗指南（2010）

五、不可切除的结直肠癌肝转移的综合治疗

结直肠癌肝转移的综合治疗包括全身和介入化疗、分子靶向治疗以及针对肝脏病灶的局部治疗如射频消融、无水酒精注射、放射治疗等。部分初诊无法切除的肝转移灶，经过系统的综合治疗后可转为适宜手术切除[51，140]。其术后5年生存率与初始肝转移灶手术切除的患者相似[113，141-142]。综合治疗也可明显延长无法手术的结直肠癌肝转移患者的中位生存期，明显改善生存质量[143-146]。因此，积极的综合治疗对于不可切除结直肠癌肝转移患者的意义重大。

(一) 治疗策略

1．结直肠癌确诊时合并无法手术切除的肝转移：

(1) 结直肠癌原发灶存在出血、梗阻或穿孔时，应先行切除结直肠癌原发病灶，继而全身化疗(或加用肝动脉灌注化疗)，可联合应用分子靶向治疗[127，147-148] (1b类证据，A级推荐)。每2～3个周期治疗后，进行肝脏超声检查、增强CT或(和)MRI，予以评估[99]。如果肝转移灶转变成可切除时，即予以手术治疗：如果肝转移灶仍不能切除，则继续进行综合治疗[149-150]。

(2) 结直肠癌原发灶无出血、梗阻或穿孔时也可选择先行切除结直肠癌的原发病灶，继而进一步治疗，具体方案同上。或者先行全身化疗(或加用肝动脉灌注化疗)，时间为2～3个月，并可联用分子靶向治疗[147] (1c类证据，B级推荐)。如果转移灶转化成可切除时，即手术治疗(一期同步切除或分阶段切除原发病灶和肝转移灶)：如果肝转移灶仍不能切除，则视具体情况手术切除结直肠癌原发病灶，术后继续对肝转移灶进行综合治疗。

对于肝转移灶有潜在切除可能的患者，建议适当增加化疗强度，如可考虑试用FOLFOXIRI方案，并可联合分子靶向治疗。

2．结直肠癌术后发生的无法手术切除的肝转移：

(1) FOLFOX和FOLFIRI化疗方案是目前结直肠癌肝转移的一线化疗方案；并可互为二线[9，151-152]。在肝转移发生前12个月内使用过FOLFOX作为辅助化疗的患者，应采用FOLFIRI方案，并可加用分子靶向治疗，或联用肝动脉灌注化疗[87] (1b类证据，A级推荐)。

(2) 既往采用5-FU／LV或单用卡培他滨治疗者、或既往未化疗者，或FOLFOX辅助化疗距今大于12个月者，可采用FOLFOX或FOLFIRI化疗方案或既往有效的化疗方案，并可加用分子靶向药物治疗，或联用肝动脉灌注化疗[147，153] (3a类证据，B级推荐)。每2～3个治疗周期后，检查肝脏超声、CT或(和)MRI，予以评估。化疗有效，肝转移灶转为可切除的患者．即应接受肝转移灶切除手术，术后再予以辅助化疗；如果肝转移灶仍不能切除，则应继续进行综合治疗[99，149-150]。

(3) 应用门静脉选择性地栓塞或结扎可以使肝转移灶切除术后预期剩余肝脏代偿性增大，增加手术切除的可能。此方法被用于预计手术切除后剩余肝脏体积不足30％的肝转移患者。对于那些剩余肝脏体积在30％～40％，并且接受了强烈化疗而有肝实质损伤的患者，同样也可从中得益[154-158] (4类证据，c级推荐)。

(二) 治疗方法

1．全身化疗和肝动脉灌注化疗：

化疗开始前采用多学科参与模式，充分评估患者的身体状况和肿瘤分期，事先规划好患者的后续治疗和有严重化疗不良反应时剂量和方案的调整。开始治疗时必须考虑有效的个体化治疗、化疗的安全性以及将来手术治疗的可能性[15]。

可以耐受联合化疗的初治患者、既往未化疗者或化疗停止超过12个月的患者建议使用FOLFOX、CapeOX或FOLFIRI方案。上述方案可联合应用分子靶向治疗。对于一般状况良好、肝转移灶有潜在切除可能并可耐受强烈化疗的患者，也可考虑应用FOLFOXIRI方案[145，159]。

(1) FOLFOX、FOLFIRI、CapeOX方案或联合分子靶向治疗，如果病情进展可以考虑互为二线，如果病情第二次进展，则可以改用分子靶向治疗(未用过此类药者)或进行最佳支持治疗[28] (2a类证据。B级推荐)。

(2) 5-FU/LV联合分子靶向治疗可用于不能耐受伊立替康、奥沙利铂的患者。其不良反应低，但生存期也比上述方案短。如果病情进展，应改用FOLFOX、FOLFIRI或CapeOX (均可联合分子靶向治疗)，病情再次进展时进行最佳支持治疗[160] (3b类证据，B级推荐)。

对于最初联合化疗难以耐受的患者，推荐卡培他滨单药或5FU(LV)治疗，均可联合分子靶向治疗。肝转移患者在肝功能状况无法改善时应当接受最佳支持治疗，肝功能改善后应尽早进行联合化疗和(或)联合分子靶向治疗[161] (3b类证据，B级推荐)。

上述治疗期间可在适当时机联合应用肝动脉灌注化疗，可能有助于延长总体生存期，单纯肝动脉灌注化疗并不比全身化疗更具优势[162]。

2．分子靶向治疗：

在结直肠癌肝转移的治疗中加入分子靶向药物，其有效性已得到广泛的证实[43，113，163-165]。目前认为，化疗联合应用靶向分子药物治疗是提高肝转移灶切除率的最有前景的治疗方法。

西妥昔单抗为EGFR的抗体，现有的研究已显示，西妥昔单抗单用或联合应用伊立替康治疗结直肠癌肝转移有良好的临床效果，其中西妥昔单抗和伊立替康联合应用具有更高的局部缓解率[9，128，166-169]。有Ⅲ期临床研究证实，在化疗基础上联合使用西妥昔单抗可以使结直肠癌肝转移灶的无残留病灶切除率提高l倍以上[128，140] (1b类证据，A级推荐)。但是，西妥昔单抗的治疗效果与肿瘤组织的K-ras基因的状态密切相关，K-ras基因野生型患者治疗有较好的效果，而K-ras基因突变型患者效果不理想[123-128]。

贝伐珠单抗为VEGF的抗体。多项临床研究的结果表明，贝伐珠单抗加5-FU/LV作为不可切除的结直肠癌肝转移一线治疗有良好的效果[147，170-172]。近期的结果还显示，贝伐珠单抗联合奥沙利铂或伊立替康也能明显提高患者的中位生存率、局部缓解率和切除率[148，173-175]。同样，贝伐珠单抗在肿瘤进展后二线治疗上的疗效也得到了证实(一线未使用过贝伐珠单抗者) [165]。贝伐珠单抗易引起出血和伤口延迟愈合，所以如在其治疗后需进行手术，建议手术时机选择在最后一次贝伐珠单抗使用后的6～8周[110，118-122]。

尽管分子靶向药物的治疗效果可喜。但目前的研究资料不建议多种靶向药物联合应用。[122，176-177]

3．射频消融：

射频消融术使用方便，且能高效破坏肝转移灶的肿瘤细胞，但其在结直肠肝转移治疗中的地位仍有争议[31，178-179]。现有资料表明，单独使用射频消融治疗肝转移的生存率仅略微高于其他非手术治疗者[180-182]。目前仅作为化疗无效后的治疗选择或肝转移灶术后复发的治疗[182]。建议应用时选择肝转移灶最大直径小于3 cm且一次消融最多3枚者[8，16，183] (5类证据，D级推荐)。肝转移灶的解剖位置是制约射频消融应用的另一个方面，肿瘤邻近大血管使瘤内温度下降过快，从而使肝转移灶不能完全消融；同时，也应注意肝外热损伤[16，184-186]。

以下情况也可考虑射频消融：(1)一般情况不适宜、或不愿意接受手术治疗的可切除结直肠癌肝转移患者；(2)预期术后残余肝脏体积过小时，可先切除部分较大的肝转移灶，对剩余直径小于3 cm的转移病灶进行射频消融。

4．放射治疗：

对于无法手术切除的肝转移灶，若全身化疗、肝动脉灌注化疗或射频消融无效，可考虑进行放射治疗，但不作常规推荐。

由于全肝放射耐受剂量远低于肿瘤细胞的致死剂量，常规放射治疗在肝转移的治疗中仅能起到姑息作用。无肝硬化时的安全照射剂量为30 Gy．虽然该剂量可以显著地减轻由于肝脏侵犯而引起的疼痛或黄疸 [187-188]，但尚没有依据表明能控制疾病或延长生命。为了减少放射性肝损伤，采用超分割或限制肝脏受照射体积，针对转移灶的局部剂量可提高到60-70 Gy [16，188-189]。如果有足够的正常肝脏组织被保护，肝脏的一部分受高剂量照射将不会产生严重的放射性肝病 [16，190] (3b类证据，B级推荐)。随着放疗设备的发展，最近出现的诸如射波刀等立体定向放射治疗(SBRT)，对小的(直径小于5 cm)不能切除的结直肠癌肝转移进行低分割放疗是安全有效的，放疗前肝功能必须正常，肝脏受到射线的剂量必须在安全范围，以防止放射性肝损伤出现[191，192]。

5．其他治疗方法：

其他治疗方法包括无水酒精瘤内注射、冷冻治疗和中医中药治疗等．但其疗效并不优于上述各项治疗．仅作为综合治疗的一部分．单独使用可能会失去其治疗意义。

纽约Sloan-Kettering对结肠癌肝转移的主要疗法

纽约Memorial Sloan-Kettering对结肠癌肝转移的主要疗法

五种主要疗法

1. Surgery
2. Image-Guided Therapies
3. Chemotherapy
4. Biologic Therapies
5. Radiation Therapy

Surgery

1 A study of patients treated at Memorial Sloan-Kettering -- including those with more advanced disease - found that most of the patients who were disease-free five years after surgery were cured (did not experience a recurrence of their tumors more than ten years later).

2 Despite its effectiveness, liver surgery is a challenging procedure that requires a team of experienced doctors who focus exclusively on treating patients with liver tumors. Many of the major blood vessels running to and from the heart pass behind or through the liver, essentially connecting these organs. In addition, the liver can tear easily and bleeds profusely when injured. Each year, surgeons at Memorial Sloan-Kettering treat more than 500 patients with liver metastases. Our doctors have developed and refined several techniques to improve the safety and effectiveness of surgery to remove liver metastases:

When possible, our surgeons perform surgery to remove primary colorectal tumors and liver metastases during the same operation, rather than during two separate procedures. This combined approach to surgery has been shown 3 to significantly reduce the number of complications and recovery time for patients.
Our surgeons have refined techniques that minimize blood loss and the need for transfusions during surgery.

To further improve the chance of a good surgical outcome, interventional radiologists at Memorial Sloan-Kettering may perform a preoperative procedure called portal vein embolization. This procedure takes advantage of the liver's capacity to regenerate (including associated blood vessels) and its dual blood supply. Interventional radiologists redirect the blood supply to the healthy portion of the liver to stimulate cell growth before surgery. This technique improves recovery from liver resection by increasing the size of the liver that will remain after surgery.

When possible, our doctors also use liver-sparing surgical techniques that leave more of the healthy liver intact, reducing the need for regeneration and the possibility of complications.

Laparoscopic（腹腔镜）Surgery
When possible and appropriate, Memorial Sloan-Kettering surgeons use minimally invasive laparoscopic surgery to remove liver tumors. Having laparoscopic surgery can significantly reduce patient recovery time compared with traditional surgery. In this procedure, surgeons insert a thin, lighted tube with a camera on its tip through a tiny incision in the patient's abdomen. Special surgical instruments are guided through the laparoscope to remove tumors or, in selected cases, part of the liver.

Image-Guided Therapies
Many patients are not eligible for surgical removal (resection) of liver tumors because their cancer is too advanced. Image-guided therapies, which use imaging techniques such as CT, ultrasound, x-ray, and MRI to guide the delivery of treatments directly to the tumor site, offer an effective way to control, rather than cure, cancer. In addition, image-guided therapies can be used to enhance the effectiveness of other treatments, such as surgery.

Image-guided therapies are either delivered by a needle that is placed in the tumor to destroy tumor cells (ablation) or through a specially designed tube (catheter) that is threaded into the artery that supplies blood to the tumor. Image-guided therapies may be used alone, with other minimally invasive therapies, prior to or during surgery, or in combination with chemotherapy. In most cases, these procedures are performed by interventional radiologists on an outpatient basis or with a short hospital stay. Because image-guided therapies are targeted directly to the tumor, they kill cancer cells while sparing healthy liver tissue.

Thermal Ablation （热消融）
In thermal ablation, heat or cold is used to destroy liver metastases. There are currently three types of thermal ablation, including radiofrequency ablation, which uses radiowaves to superheat the tumor; microwave ablation, which uses microwaves to heat tumor cells; and cryoablation, which freezes the tumor. Doctors prescribe heat or cold depending on the size, location, and shape of the tumor.

Increasingly, ablation is performed by our surgeons in combination with liver surgery to remove tumors that may be considered inoperable at other hospitals, such as metastases that occur on both sides of the liver. Ablation also may be used to reduce the risk of recurrence for patients with liver metastases that cannot be completely removed with surgery alone. In addition, ablation may prolong survival for patients with recurrent metastases who were previously treated with surgery and chemotherapy. Ablation may be selected in place of surgery for patients who are too sick to undergo a surgical procedure.

Ablation often can be performed with minimally invasive techniques by our interventional radiologists, who deliver ablative therapies percutaneously (with a specially designed needle that is inserted through the skin). In addition, our surgeons may use a laparoscope (described above) to deliver ablative therapies. In some cases, ablative therapies may be delivered through a catheter with techniques called embolization or radioembolization (discussed below).

Memorial Sloan-Kettering is conducting a study supported by the NIH to help predict patients' response to treatment following ablation of colorectal liver metastases.

Radioembolization （放疗栓塞）
Radioembolization has recently been approved by the FDA to treat selected patients with colorectal liver metastases. In this technique, a catheter is placed into the hepatic artery, which supplies blood to the tumor. An interventional radiologist first injects dye into the catheter to identify the location of the tumor. Specially designed beads containing radioactive material are then inserted into the catheter, delivering a therapeutic dose of radiation to the tumor while sparing the healthy portion of the liver and other parts of the body.

Memorial Sloan-Kettering is conducting a clinical trial to study radioembolization in patients with colon cancer who did not respond to initial treatment with chemotherapy.


Chemotherapy
In recent years, the use of more effective chemotherapy drugs such as oxaliplatin and irinotecan has contributed to significant improvements in survival for patients with liver metastases. Medical oncologists at Memorial Sloan-Kettering use chemotherapy to reduce the risk of tumor recurrence following surgery (adjuvant therapy) and also to help shrink tumors prior to surgery (neoadjuvant therapy). Chemotherapy may be delivered systemically (throughout the body) through intravenous infusion or directly to the affected region with a procedure called hepatic arterial infusion.

Hepatic Arterial Infusion (肝动脉灌注 HAI) ChemotherapyMemorial Sloan-Kettering has significant experience with the use of HAI chemotherapy. This chemotherapy technique delivers a high dose of chemotherapy drugs into the hepatic artery -- the main source of blood and nutrients for liver tumors -- through a tiny pump implanted under the skin in the lower abdomen. Additional chemotherapy medicine is injected into the pump, as needed, on an outpatient basis.

HAI chemotherapy may be given alone or in combination with systemic chemotherapy as adjuvant therapy or neoadjuvant therapy. Our doctors have found that HAI chemotherapy prolongs survival for some patients following surgery. In addition, because HAI chemotherapy is delivered regionally (only to the tumor site), it causes fewer toxic side effects and has been associated with better physical functioning than systemic chemotherapy.

In a number of patients who cannot have liver metastases removed because of their number, size, or location, HAI plus systemic therapy can reduce tumors so that resection can become possible.

Chemotherapy as a Bridge to Surgery
Increasingly, doctors are using chemotherapy drugs to shrink tumors in patients with a variety of metastatic cancers. As a result, many patients with tumors that were once considered inoperable may safely undergo surgery - increasing the chance of a cure. Doctors at Memorial Sloan-Kettering routinely use systemic or regional chemotherapy as a bridge to surgery in patients with colorectal liver metastases. Studies have shown that nearly one-third of patients with "initially unresectable" colorectal liver metastases who undergo surgery following chemotherapy survive beyond five years, increasing the chance of a cure.

Investigational Approaches to Chemotherapy
At Memorial Sloan-Kettering, our investigators are constantly evaluating new chemotherapy combinations that may improve the standard of care for patients with liver metastases. These investigational therapies are sometimes offered to eligible patients through our clinical trials.

General side effects, such as fatigue, nausea, and diarrhea, can be expected from any chemotherapy drug or combination of drugs, but side effects vary from patient to patient. Talk to your doctor about possible side effects before starting a chemotherapy treatment regimen.

Biologic Therapies
Unlike chemotherapy drugs, which kill both cancer cells and healthy cells, biologic therapy offers a targeted approach to fighting cancer by stopping the replication of tumor cells and/or disrupting a tumor's blood supply. Biologic therapy is now used in combination with many chemotherapy drugs to improve the effectiveness of treatment. Biologic therapies include:

Anti-Angiogenesis （抑制血管生成）Therapy
These drugs, used in combination with chemotherapy, stop the growth of blood vessels that nourish tumors. Anti-angiogenesis drugs such as bevacuzimab (Avastin®) may be given before or after surgery.

Epidermal Growth Factor Receptor (EGFR) Inhibitors
These drugs block epidermal growth factor receptor, a protein that may contribute to the progression of colorectal cancer. EGFR therapy with cetuximab or panitumumab is not effective for patients with a specific type of mutation in a gene called KRAS. Laboratory tests are now used to screen patients with liver metastases for this mutation and determine whether EGFR therapy is appropriate. In addition, clinical studies are underway to evaluate drugs, including novel therapies, that may be effective in treating tumors with this mutation.

Radiation Therapy
Radiation therapy is used in selected cases to help control liver metastases that cannot be surgically removed or are too large to be treated effectively with ablation. Our radiation oncologists work with specialists from our medical physics department to develop an individualized treatment plan using the latest techniques to deliver radiation directly to the tumor and minimize damage to healthy liver tissue and surrounding organs.

One technique, intensity-modulated radiation therapy (IMRT), uses radiation beams of varying intensity that are molded to the shape of the tumor. Using highly sophisticated computer software and 3-D images from CT scans, radiation is focused on cancerous tissue with greater precision than conventional radiation therapy.

Another approach, known as stereotactic body radiation therapy, uses a highly focused radiation field to deliver greater doses of radiation in fewer treatments. Stereotactic body radiation therapy combines IMRT and image-guided radiotherapy (IGRT), which uses tiny gold seeds that are implanted into the tumor to act as a visual guide during imaging. A CT scan reveals the exact location of the seeds, helping guide radiation directly to the tumor site.

Because tumors and organs in the abdomen shift during breathing, precise delivery of radiation therapy to cancerous tissue can be difficult. Doctors at Memorial Sloan-Kettering use motion-management techniques to target liver metastases while sparing healthy tissue. Respiratory gating is a motion-management technique that delivers radiation only at certain points during a patient's breathing cycle, when mobile tumors are in a specific position. In some cases, the radiologist will employ a technique called abdominal compression, which uses a specially designed compression belt to apply pressure to the abdomen to help minimize tumor movement during treatment. Our researchers are also evaluating the use of anesthesia to minimize respiratory motion during radiation treatments.Surgery to remove liver tumors (surgical resection) -- often in combination with chemotherapy -- is the most effective treatment for patients with liver metastases from colorectal cancer that are limited in size and number. Studies suggest that up to 50 percent of patients who undergo surgery to remove colorectal liver metastases survive for at least five years.

晚期结肠癌中药治疗

晚期结肠癌中药治疗
南京抗癌网/结肠癌药物
2011-01-13

   晚期结肠癌治疗方法主要是有手术的治疗，放射治疗和化学的治疗，当然其中不能缺少还有药物的治疗，尤其是中药的治疗。晚期结肠癌的治疗是否选用手术应需要根据患者体质和病情来决定的，因为晚期结肠癌多数都已经发生了转移和扩散，手术的几率较小。一般的来说，晚期结肠癌的患者多数是采用放化疗的治疗来延长患者的生命的，因为强烈毒副作用，临床常用中药进行辅助治疗。
　 晚期结肠癌治疗需要采用中医中药的整体治疗，用中医治疗首先控制病情进一步转移，改善患者的临床症状，在这各基础上来治疗恶性肿瘤，通过有效药物，合理饮食，适当锻炼等全身整体治疗。晚期结肠癌治疗在使用放疗和化疗之后，如果要是能够配合中药治疗来降低其毒副作用，杀死癌细胞的同时，提高机体免疫力，延长生命。
　 临床上用于晚期结肠癌的治疗中药有：食道平散、抗癌平丸、西黄丸等；若有结肠癌的扩散转移，可选用复方斑蝥胶囊、华蟾素口服液、鸦胆子油口服液、西黄丸、消癌平片等来配合治疗；升血调元汤、参芪十一味颗粒等中药能够有效的减轻放化疗副作用；如果晚期如出现了疼痛，中药博生癌宁等是理想选择，如疼痛发展难以控制时，我们可以再考虑用成瘾性止痛药。
　 抗癌平丸：能够有效的抑制消化系统恶性肿瘤细胞增殖，抑制了肿瘤生长；激发机体免疫功能，控制或延缓复发，延长了患者的生命;控制原发病灶及转移灶的继续扩散;增强放、化疗效果;减轻放、化疗的毒副作用，促进术后恢复。
　食道平散：药性平稳、抗炎消肿，镇痛和改善循环的作用，并能够补充人体部分微量元素，提高机体免疫力，杀死癌细胞和抑制癌细胞生长，并防止癌细胞扩散。该药为散剂含化物，服用方便，可使药物有效成分直达病灶，起到立竿见影的临床治疗效果。
　华蟾素口服液：是纯中药口服液体制剂，而且服用起来比较方便，有利于药物快速的吸收，而且还能够避免了经肝脏、肾脏代谢导致的肝肾功能损害，能够从根本上提高了患者的生活质量。特别是对于中、晚期癌症患者具有显著疗效，治疗肿瘤稳定率可达80.74%，配合放化疗还可显著升高白细胞，治疗骨髓抑制，具有明显的增效减毒作用。
　晚期结肠癌的治疗，多数是提倡带瘤生存，在诸多的治疗方法当中，中药的治疗是一个很好的选择，临床上已证明其疗效稳定可靠，可见晚期结肠癌中药治疗是十分有效的，值得大力推广及应用。

结肠癌晚期治疗方法和治疗药物
南京抗癌网/结肠癌药物　　
2010-11-23
  结肠癌晚期治疗除了要控制结肠癌的症状以外，还需要抑制结肠癌的扩散和转移，结肠癌晚期治疗方法和治疗药物相结合，能够起到最佳的治疗的效果的。临床上常用的中药主要是单独的治疗或者是配合放化疗的同时治疗，能够有效的治疗原发癌肿的同时还能出现转移的病灶，防止继续扩散和转移，具体的结肠癌晚期治疗方法和治疗药物是需要根据患者的体质和病情的决定。
  结肠癌晚期治疗过程中，手术治疗已经是不能够完全切除，而患者也是不能够承受的。一般的来说，结肠癌晚期治疗能够采用放化疗控制症状，可是放化疗能够导致患者更加的疲劳，损害了患者机体的免疫力，而且对于患者的机体的正常的细胞也有着毒副作用，需要配合中药的治疗起到增效减毒的作用，临床上一般配合放化疗很好的中药主要是有参芪十一味颗粒和升血调元汤等，降低了放化疗的副作用的同时还能够有效的增强了患者的免疫功能，加强了放化疗的治疗疗效。
  临床上结肠癌晚期治疗药物主要有西黄丸，珍香胶囊，抗癌平丸，华蟾素口服液，复方斑蝥胶囊等，这些中药能够杀灭结肠癌的细胞，控制了结肠癌的症状，有效的增强了结肠癌晚期的免疫功能，副作用比较小，疗效比较好，安全无毒，能够赢得了很多的患者的信赖。
  我们都知道，结肠癌晚期恶性肿瘤已经发生扩散和转移的，腹腔肝脏是结肠癌主要的转移的部位，其次主要是骨转移，结肠癌术后患者每隔三月复查腹腔了，便于判断疗效和指导治疗。能够有效的控制结肠癌扩散转移，临床上可以选用复方斑蝥胶囊，华蟾素口服液，鸦胆子油口服乳液；如果患者晚期出现疼痛，中药博生癌宁在止痛的方面能够取得疗效，也可以通过饮食来缩小恶性肿瘤，来减轻患者的痛苦。结肠癌晚期的患者要注意日常的饮食调理，患者的身体机能好了，免疫力强，才能够抵抗癌肿的发展，耐受各种药物的治疗。在饮食上，要尽量的减少饮食中的油脂的摄取‘增加饮食中纤维素的摄取，禁忌烈酒，辛辣，燥热，刺激性的食物。

部分抗癌中成药

抗癌中成药及肠癌组盒用药方案

肺癌专用药品
 
金复康口服液
清肺散结丸
特罗凯埃罗替尼
益肺清化膏
易瑞沙吉非替尼
参莲胶囊
参莲颗粒
益肺清化颗粒

肝癌专用药品
 
华蟾素口服液
肝复乐胶囊
慈丹胶囊
金龙胶囊
珍香胶囊
肝复乐片

胃癌、食道癌、贲门癌、肠癌药品

珍香胶囊
抗癌平丸
仙蟾片
食道平散

胃癌、食道癌、贲门癌、肠癌组盒用药方案
多发转移 安康欣胶囊＋抗癌平丸＋参芪十一味颗粒
多发转移 食道平散＋仙蟾片＋参芪十一味颗粒
多发转移 龙圣堂消癌平片＋华蟾素口服液＋参芪十一味颗粒
多发转移 抗癌平丸＋龙圣堂消癌平片＋参芪十一味颗粒
多发转移 仙蟾片＋鸦胆子油软胶囊＋参芪十一味颗粒

高效广谱抗癌药,治疗各种肿瘤

安康欣胶囊
参丹散结胶囊
鸦胆子油口服乳液
鸦胆子油软胶囊
参一胶囊
华蟾素片
华蟾素胶囊
消癌平糖浆
神源消癌平片
龙圣堂消癌平片
西黄丸
复方斑蝥胶囊
癌症引起的疼痛等症状
志苓胶囊
蟾乌巴布膏
复方蟾酥膏
天蟾胶囊
科洛曲片
阿魏化痞膏

癌症引起的胸水、腹水专用药

臌症丸
 
提高骨髓造血\防止转移\放化疗辅助

参芪十一味颗粒
贞芪扶正颗粒
健脾益肾颗粒
养阴生血合剂
灰树花胶囊
微达康颗粒

其他抗肿瘤药
 
威麦宁胶囊
参蟾消解胶囊
金克槐耳颗粒
软坚口服液
解毒维康片
紫龙金片
金水鲜胶囊
替莫唑胺胶囊
双灵固本散
天芝草胶囊
胸腺肽肠溶片
复生康胶囊
平消胶囊
复方红豆杉胶囊
赛诺金干扰素α-1b
白消安片
希罗达
得生消癌平片
金花联瑭素
日达仙胸腺肽α1
破壁灵芝孢子粉软胶囊
灵芝孢子油软胶囊胶囊
参红祛瘀散结胶囊
盐酸格拉司琼片
吕中复方斑蝥胶囊
无为消癌平片
三正消癌平片
阿魏化痞膏
消癌平口服液
固元胶囊
都生消癌平片
消癌平胶囊
大黄蟄虫丸
微达康颗粒
硫鸟嘌呤片
赫赛汀
复方万年青胶囊
安柯瑞
复方皂矾丸
六甲蜜胺片
消癌平颗粒
依斯坦
速复健
康莱特软胶囊
欣康艾胶囊
替吉奥胶囊
托泊替康
香菇菌多糖片
枫苓合剂
851口服液
艾瑞宁
芙达龙
博生癌宁
癌痛搽剂
金因肽
高三尖杉酯碱
志苓胶囊
康莱特注射液
恩度
益血生胶囊
螺旋藻胶囊
贞芪扶正胶囊
猪苓多糖注射液
金水宝胶囊
多西他赛
甘露聚糖肽片
血复生片
去甲斑蝥素片
艾必妥
依诺金软胶囊
银耳孢糖肠溶胶囊
康复新液
鼻咽清毒颗粒
甲基斑蝥胺片
复方苦参注射液
复方芦笋合剂
爱必妥
盐酸吡柔比星
盐酸表柔比星
盐酸阿霉素
甲氨蝶呤
阿糖胞苷
司莫司汀
盐酸柔红霉素
环磷酰胺
六甲蜜胺胶囊
氟尿嘧啶片
替加氟片
卡铂
洛莫司汀胶囊
羟基脲片
门冬酰胺片
硫酸长春地辛
羟喜树碱
硫酸长春碱
依托泊苷
氨鲁米特
顺铂
异环磷酰胺
宫瘤消胶囊
恩丹西酮胶囊
舍力丹胶囊
宫颈癌片
猪苓多糖胶囊
银耳孢糖胶囊
盐酸表阿霉素
颐圣复方斑蝥胶囊
盐酸表阿霉素
扶康胶囊
奥沙利铂乐沙定
紫杉醇注射液
卡莫司汀

抗癌中成药选用注意事项

癌症是造成人类死亡的疾病之一，严重威胁着人类健康。现代医学认为，其发生的根本原因是正常细胞核基因的异常改变。中医学认为，气机不利、瘀血阻滞、湿痰凝聚、毒邪内聚、正气亏虚是肿瘤发生的主要机制。活血化瘀、清热解毒、软坚散结、扶正固本是中医药治疗肿瘤的四大基本法则。中成药依据中医“扶正祛邪”的理论,多具有益气活血,散结消,理气化瘀的功效。在治疗肿瘤和辅助治疗肿瘤等方面疗效颇佳,且具有毒副作用小的特点。

一、抗癌药选择的“三查”.通过大型搜索网站或国家药品监督局网站三查！
1、首先要查该药品是否正规厂家生产、是否具有国家正式药品批准文号。这样可以避免有些小诊所将自己的小配方冒充国家正规药品鱼目混珠，也可以帮助患者鉴别著名大型厂家的品牌与一般小生产厂家，比如同样是鸦胆子油口服乳液，广州白云山生产的就比一般小厂家疗效更有保障。同样是消癌平片，海南龙圣堂作为抗癌药物专业生产厂家质量就更加可靠,等等.
2、其次要查药品经销单位是否合法和药品来源。很多小经营单位经常打着国家著名医药单位的旗号愚弄患者，这时患者要做的事情很简单：通过114查询后直接向这些著名机构打电话咨询是否属实。如果该单位并不认可这些经营者，那么他们的药品你还是要小心为好！如果您需要核实对方的药品来源是否正规，办法也很简单：直接向生产单位打电话查询是否向该经营单位供货！郑重提醒患者及家属,首次购药最好亲自上门落得心里踏实,实在不方便可委托当地朋友最起码核实一下对方单位的真实性!
3、最后要查对方所宣传的专家人员身份,这点很重要!因为肿瘤药品相对比其它类药品更加需要注意用药的安全性,而这些只有医生可以帮助您.如果您已经在大医院咨询过只是为了买药,那么找药店购买应该比较方便.如果您需要了解更多,那么最好找有医生坐诊的医院和门诊.而很多药店正是利用患者需要找医生咨询的心理,在宣传上也有意罗列一堆专家,稍有常识的患者都会马上识破他们是虚假的,甚至连专家名字都是假的!.
二.抗癌药品选择的"三问".选好正规经营单位后您一定要问清楚再购买,否则有可能买回来的不是您需要的药品.
1.需要问清楚该药品的治疗范围.很多患者常常被一些利益熏心的虚假宣传所诱导,或者受其他不同癌种患者服用后的启发,往往会出现盲目购药.不管哪种药品都一定是有国家严格规定的适应症范围,并非是万能的,超越规定范围不一定完全没效果,但总是不如选择一种针对性更强的药品理想.
2.需要问清楚药品的服用方法.比如癌症引起的胸水腹水专用药臌症丸是需要在饭前服用的,很多患者却往往在饭后服用,效果自然就大打折扣了!
3.需要问清楚药品的禁忌症.比如癌性疼痛专用药天蟾胶囊虽然止痛效果不错,但如果患者同时有心脏病,那么该药服用就有一定的危险性.
三.以下三种情况下的药品最好不要购买或谨慎购买
1.虚假宣传的药品不能购买:有些单位宣传他们的药品使成千上万例患者彻底康复,这根本就违背了科学,癌症到目前为止还是世界性的难题,治疗能解决的也只是延长寿命和提高患者生存质量.
2.比正常价格低得离谱的药品不能购买.药品适当优惠是正常的,如果太离谱就需要认真核实药品的真伪,或者有效期已过.
3.非药品类保健食品.经常会遇到一些患者只是长期服用某某孢子粉等保健品的情况,不排除该类产品具有一定的保健作用,但是它与参芪十一味颗粒\健脾益肾颗粒\贞芪扶正颗粒等国药准字的提高免疫力药品仍具有很大差距.一个最简单的道理: 如果保健品真有那么好的效果,那么国家不会仅仅把其当作保健品.