Preliminary Efficacy and Safety of Camrelizumab in Combination With XELOX Plus Bevacizumab or Regorafenib in Patients With Metastatic Colorectal Cancer: A Retrospective Study

Abstract

BackgroundFor a majority of patients with metastatic colorectal cancer (mCRC) with MS stable (MSS) or mismatch repair proficient (pMMR), the role of immunotherapy is undetermined. This study investigated the efficacy and safety of camrelizumab when added to XELOX chemotherapy plus bevacizumab or regorafenib as first-line therapy for mCRC.Materials and MethodsMedical records of mCRC patients who received camrelizumab and XELOX plus bevacizumab or regorafenib at the First Hospital of Quanzhou Affiliated to Fujian Medical University between June 1, 2019, and April 30, 2021, were retrospectively collected. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and side effects of the drug were recorded and reviewed.ResultsTwenty-five eligible patients received combination therapy, including bevacizumab in 19 patients and regorafenib in 6. Twenty-one patients had pMMR/MSS and one MSI-H. Of the 25 patients who could be evaluated for efficacy, 18 (72%) achieved PR, 6 (24%) achieved SD, and 1 (4%) achieved PD. The ORR and DCR were 72% (18/25) and 96% (24/25), respectively. The median progression-free survival (PFS) was 11.2 months (95% CI 8.9–13.9), and OS had not yet been reached. The combination regimen of regorafenib in six (24%) patients was unassociated with treatment outcomes. Most AEs were either grade 1 or 2, and treatment-related grade 3 toxicities were observed in 8/25 (32%) patients.ConclusionCamrelizumab combined with XELOX plus bevacizumab or regorafenib was feasible, producing high rates of responses as first-line therapy in unselected Chinese patients with MSS mCRC. The toxicities were generally tolerable and manageable. Prospective randomized trials with large sample sizes are needed to evaluate these findings.

Efficacy and safety of camrelizumab plus apatinib compared to apatinib monotherapy as third‐line or above therapy for metastatic colorectal cancer patients: A retrospective cohort study

“…Besides, most of the adverse events were mild and controllable. Moreover, all of the adverse events that occurred in this study were also reported by previous studies, and no new adverse events were reported 14,22–24 . This finding indicated that camrelizumab plus apatinib treatment might be safe for mCRC patients.…”

“…The most frequent adverse events of cancer patients receiving camrelizumab plus apatinib or apatinib are leukopenia, anaemia, fatigue, pruritus, neutropenia, nausea and vomiting, hand‐foot syndrome, and hypertension according to previous studies; notably, the grade 3–4 adverse events rarely occur 14,22–24 . The present study found that the incidence rate of common adverse events was similar between patients receiving camrelizumab plus apatinib and patients receiving apatinib as third‐line or above therapy.…”

“…Notably, the decision of which treatment to use was based on the following considerations: (1) patients' actual conditions; (2) doctors' advice; (3) patients' own choice. The recommended usage of camrelizumab was 200 mg every 3 weeks 14 ; the initial administration of apatinib was 375 or 500 mg/d (500 mg/d for patients with ECOG PS score of 0–1, 375 mg/d for patients with ECOG PS score of 2), 12,13 and the apatinib dose could be altered to 250 mg/d according to the patients' tolerance (24/31 (77.4%) patients in camrelizumab plus apatinib group and 23/33 (69.7%) patients in apatinib group adjusted the apatinib dose). Patients in the two groups above received the therapy until disease progression or intolerance.…”

Microsatellite stable metastatic colorectal cancer without liver metastasis may be preferred population for regorafenib or fruquintinib plus sintilimab as third-line or above therapy:A real-world study

“…The toxicity profile of this combination regimen was tolerable and was comparable with previous studies ( 28 – 30 ). The REGONIVO study demonstrated that combination of regorafenib 80 mg plus nivolumab had a manageable safety profile and encouraging antitumor activity.…”

Early low blood MALT1 expression levels forecast better efficacy of PD‑1 inhibitor‑based treatment in patients with metastatic colorectal cancer

“…Over the decades, PD-1 inhibitor-based treatment has been widely applied for cancer treatment, where it plays an antitumor role by inhibiting immune escape through accelerating the antitumor immune response and promoting sensitivity to radio-chemotherapy (10)(11)(12). Certain studies have also reported that PD-1 inhibitor-based treatment provides survival benefits in patients with mCRC (13)(14)(15). However, >50% of patients with mCRC fail to respond to PD-1 inhibitor-based treatment, which consequently impairs their prognosis (16,17).…”