PD-1单克隆抗体治疗实体器官移植术后恶性肿瘤的系统评价  

Systematic evaluation on PD-1 monoclonal antibody in the treatment of malignant tumor after solid organ transplantation

作　　者：宾阳阳 李杰群[1] 李强[1] 周政俊 周依 陈广顺[1] 齐海智[1] 司中洲[1] Bin Yangyang;Li Jiequn;Li Qiang;Zhou Zhengjun;Zhou Yi;Chen Guangshun;Qi Haizhi;Si Zhongzhou(Department of General Surgery and Transplantation,Xiangya Second Hospital of Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅二医院普外移植科,长沙410013

出　　处：《器官移植》2020年第3期384-390,共7页Organ Transplantation

基　　金：国家自然科学基金(81102241);湖南省自然科学基金(2018JJ2561)。

摘　　要：目的探讨实体器官移植(SOT)术后使用程序性细胞死亡受体-1(PD-1)单克隆抗体(单抗)治疗恶性肿瘤的有效性和安全性。方法检索7个数据库中的相关文献。收集54例SOT受者术后使用PD-1单抗治疗恶性肿瘤的案例,对使用PD-1单抗的SOT受者的临床效果及排斥反应情况进行分析。结果共纳入符合标准的文献32篇,共54例SOT受者。其中男43例,女11例,年龄为14~79岁。包括29例肾移植受者、19例肝移植受者、6例心脏移植受者。SOT受者使用的PD-1单抗药物类型包括28例使用派姆单抗、26例使用纳武单抗。PD-1单抗治疗SOT受者术后恶性肿瘤的总体缓解率为32%(17/54),疾病进展率44%(24/54),病死率为36%(19/54)。PD-1单抗治疗SOT受者术后恶性肿瘤后,排斥反应发生率为39%(21/54)。排斥反应与PD-1单抗药物类型无明显相关性(P>0.05)。结论PD-1单抗能有效治疗SOT受者术后恶性肿瘤,治疗过程中可引发排斥反应,但排斥反应并不是导致受者死亡的最常见原因。Objective To investigate the efficacy and safety of programmed cell death protein-1(PD-1)monoclonal antibody on the treatment of malignant tumor after solid organ transplantation(SOT).Methods The relevant literatures in 7 databases were searched.The data on 54 cases of recipients with malignant tumors treated with PD-1 monoclonal antibody after SOT were collected,and the clinical effects and rejection of SOT recipients treated with PD-1 monoclonal antibody were analyzed.Results Total 32 acceptable articles including 54 SOT recipients were incorporated,including 43 males and 11 females aged 14-79 years old.There are 29 renal transplant recipients,19 liver transplant recipients and 6 heart transplant recipients.The types of PD-1 monoclonal antibody agent used by SOT recipients included pembrolizumab for 28 patients and nivolumab for 26 patients.The overall remission rate,disease progression rate and fatality rate of PD-1 monoclonal antibody for postoperative malignant tumors of SOT recipients were 32%(17/54),44%(24/54)and 36%(19/54),respectively.After treatment with PD-1 monoclonal antibody for postoperative malignant tumors of SOT recipients,the incidence of rejection was 39%(21/54),indicating no significant correlation between rejection and type of PD-1 monoclonal antibody(P>0.05).Conclusions PD-1 monoclonal antibody can effectively treat postoperative malignant tumors of SOT recipients,and may induce rejection during the treatment.But rejection is not the most common cause for death of recipients.

关 键 词：肿瘤免疫 程序性细胞死亡受体-1(PD-1) 实体器官移植 恶性肿瘤 文献分析 免疫检查点抑制剂 

分 类 号：R617[医药卫生—外科学] R730.5[医药卫生—临床医学]