免疫检查点抑制剂治疗尿路上皮癌的临床经验  

Immune checkpoint inhibitors for the treatment of urothelial carcinoma:preliminary clinical experience

作　　者：王喆[1] 吕程程 付水[1] 毕缓[1] 付成 曾宇[1] Zhe Wang;Chengcheng Lv;Shui Fu;Huan Bi;Cheng Fu;Yu Zeng(Department of Urology,Cancer Hospital of China Medical University/Department of Urology,Liaoning Cancer Hospital&Institute(Shenyang Liaoning 110042,China)

机构地区：[1]中国医科大学肿瘤医院泌尿外科,辽宁省肿瘤医院泌尿外科,沈阳市110042

出　　处：《中国肿瘤临床》2019年第24期1271-1275,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨使用免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗尿路上皮癌的临床有效性与安全性。方法:回顾性分析2016年7月至2019年4月32例于辽宁省肿瘤医院使用ICIs治疗尿路上皮癌患者的临床资料。结果:32例患者中4例完全缓解(complete remission,CR)、7例部分缓解(partial remission,PR)、5例疾病稳定(stable disease,SD)、9例疾病进展(progression disease,PD)、7例尚未评估。总客观有效率(overall response rate,ORR)为44.0%(11/25),总疾病控制率(disease control rate,DCR)为64.0%(16/25)。至少经一种含铂类化疗失败患者的ORR为33.3%(5/15),未经铂类化疗患者ORR达60.0%(6/10)。患者最多接受23个周期的ICIs治疗、约15个月,中位治疗周期为6个周期、约3.5个月。使用ICIs治疗患者通常耐受性良好,常见的免疫相关不良事件(immune-related adverse events,irAEs)为乏力、皮疹、甲减等。32例患者中5例出现irAEs,行静脉滴注皮质类固醇治疗。结论:ICIs用于铂类化疗失败的局部晚期或转移性尿路上皮癌疗效明确,对于不能耐受或不愿意接受化疗的患者,或不适合手术的原发性尿路上皮癌患者,一线使用ICIs也是临床中可行的治疗方案,对irAEs需早期识别和给予持续治疗。Objective:To investigate the clinical efficacy and safety of immune checkpoint inhibitors(ICIs)in the treatment of urothelial carcinoma.Methods:Clinical data of 32 patients with urothelial carcinoma treated with ICIs at the Department of Urology of Liaoning Cancer Hospital&Institute from July 2016 to April 2019 were retrospectively analyzed.Results:Overall,the objective response rate(ORR)and disease control rate were 44%(11/25)and 64%(16/25),respectively.Complete response,partial response,stable disease,progressive disease,and lack of evaluations were found in 4,7,5,9,and 7 patients,respectively.The ORR was 33.3%in patients who had received cisplatin-based chemotherapy and 60%for chemotherapy-naive patients.All patients received up to 23 cycles of treatment over 15 months,with a median treatment period of 3.5 months,which included six cycles.The most common adverse events related to ICI treatment(irAEs)in this group were fatigue,rash,and hypothyroidism.Among 32 patients,5(16%)received systemic corticosteroids because of irAEs.Conclusions:Second-line treatment is beneficial for unresectable local or metastatic urothelial carcinoma.For patients who might not tolerate or are unwilling to receive chemotherapy,the first-line application of ICI therapy is feasible.However,ICIs are generally well-tolerated by patients.Careful surveillance for irAEs is necessary,and early identification and continued administration of corticosteroids are important to avoid lethal events caused by irAEs.

关 键 词：免疫检查点抑制剂 尿路上皮癌 免疫相关不良事件 

分 类 号：R737.1[医药卫生—肿瘤]