新辅助免疫治疗联合化疗在可手术的非小细胞肺癌的初步疗效评估  

Preliminary Efficacy Evaluation of Neoadjuvant Immunotherapy Combined with Chemotherapy in Resectable Non-small Cell Lung Cancer

作　　者：周世杰[1] 郝学峰 于大平[1] 刘树库[1] 曹小庆[1] 苏崇玉 宋小运[1] 肖宁[1] 李云松[1] 杨威 赵丹[2] 王敬慧[3,4] 刘志东[1] 许绍发[1] Shijie ZHOU;Xuefeng HAO;Daping YU;Shuku LIU;Xiaoqing CAO;Chongyu SU;Xiaoyun SONG;Ning XIAO;Yunsong LI;Wei YANG;Dan ZHAO;Jinghui WANG;Zhidong LIU;Shaofa XU(Department of Thoracic Surgery,Beijing Chest Hospital Capital Medical University,Beijing 101149,China;Department of Pathology,Beijing Chest Hospital Capital Medical University,Beijing 101149,China;Department of Medical Oncology,Beijing Chest Hospital Capital Medical University,Beijing 101149,China;Cancer Research Center,Beijing Chest Hospital Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院胸外科,北京101149 [2]首都医科大学附属北京胸科医院病理科,北京101149 [3]首都医科大学附属北京胸科医院肿瘤内科,北京101149 [4]首都医科大学附属北京胸科医院肿瘤研究中心,北京101149

出　　处：《中国肺癌杂志》2021年第6期420-425,共6页Chinese Journal of Lung Cancer

摘　　要：背景与目的初步研究证实新辅助免疫联合化疗对可手术非小细胞肺癌近期疗效显著,但国内相关临床试验较少。本研究回顾性分析应用新辅助免疫治疗联合化疗的可手术Ⅰb期-Ⅲb期非小细胞肺癌的临床病理资料,初步评估新辅助免疫治疗联合化疗的疗效及安全性。方法回顾性分析2019年11月-2020年12月期间于首都医科大学附属北京胸科医院胸外科治疗的临床分期Ⅰb期-Ⅲb期的非小细胞肺癌患者20例,术前应用免疫联合化疗新辅助治疗,根据影像学和病理学方法分别评估疗效。结果全组患者新辅助治疗后影像学评估疗效,客观有效率(objective responserate,ORR)为85.0%(完全缓解4例,部分缓解13例),疾病稳定1例(5.0%),疾病进展2例(10.0%)。其中17例后续接受手术治疗,16例达到R0(no residual tumor)切除,1例R1(microscopic residual tumor)切除。术后病理评估:主要病理缓解率(major pathologic response,MPR)为47.1%(8/17),其中完全病理缓解率(complete pathologic response,CPR)为29.4%(5/17)。主要不良反应:免疫相关性肺炎(Ⅳ级)1例,Ⅲ级及以上血液学毒性9例(45.0%)。结论新辅助免疫联合化疗对于可手术的非小细胞肺癌近期疗效显著,具有一定的安全性及有效性。但新辅助免疫联合化疗的远期疗效、最佳周期数以及理想预测免疫治疗效果的标记物仍有待研究。Background and objective Preliminary researches conformed that neoadjuvant immunotherapy combined with chemotherapy had a significant short-term effect in resectable non-small cell lung cancer(NSCLC),but there were few clinical trials about neoadjuvant chemoimmunotherapy in China.We aimed to assess retrospectively the antitumour activity and safety of neoadjuvant chemoimmunotherapy for resectable stageⅠb-Ⅲb NSCLC.Methods Twenty patients who had been diagnosed as stageⅠb-Ⅲb NSCLC and received chemoimmunotherapy as neoadjuvant treatment between November 2019 and December 2020,in Beijing Chest Hospital,Capital Medical University were recruited.These patients received neoadjuvant treatment for 21 days as a cycle and antitumour activity and safety were evaluated every two cycles.Results Of 20 patients received neoadjuvant chemoimmunotherapy,17 patients underwent surgical resection.16 patients had R0 resection(no residual tumor resection)and 1 patient had R1 resection(microscopic residual tumor resection).Radiographic objective response rate(ORR)was 85.0%(4 complete response,13 partial response).5.0%(1/20)of patients had stable disease,and 10.0%(2/20)of patients had progression disease.The major pathologic response(MPR)was 47.1%(8/17),and complete pathologic response(CPR)was 29.4%(5/17).1 case developed gradeⅣimmune-related pneumonia(IRP)and 9(45.0%)cases had gradeⅢhematologic toxicity.Conclusion Immunotherapy combined with chemotherapy as neoadjuvant therapy has a better efficiency and tolerable adverse effects for patients with resectable NSCLC in stageⅠb-Ⅲb.

关 键 词：肺肿瘤 免疫治疗 新辅助治疗 手术 

分 类 号：R734.2[医药卫生—肿瘤]