卡瑞利珠单抗联合阿帕替尼治疗D-TACE后进展的中晚期肝癌的初步疗效及安全性分析  

Preliminary efficacy and safety analysis of carrelizumab combined with apatinib in patients with middle-advanced liver cancer progressed after drug-eluting beads-transcatheter arterial chemoembolization

作　　者：刘金[1] 曹刚[1] 张根山[1] 徐文杰[1] 刘书屹 石大群 Liu Jin;Cao Gang;Zhang Genshan;Xu Wenjie;Liu Shuyi;Shi Daqun(Department of Interventional Radiology,Lianyungang First People′s Hospital,Lianyungang 222000,China)

机构地区：[1]江苏省连云港市第一人民医院介入放射科,连云港222000

出　　处：《中华医学杂志》2021年第29期2304-2309,共6页National Medical Journal of China

基　　金：连云港市第一人民医院青年英才项目(QN1914)。

摘　　要：目的探讨卡瑞利珠单抗联合阿帕替尼在治疗载药微球-肝动脉化疗栓塞(D-TACE)后进展的中晚期肝癌中的初步临床疗效与安全性。方法回顾性分析连云港市第一人民医院2019年4月至2020年7月卡瑞利珠单抗联合阿帕替尼治疗的23例D-TACE后进展的中晚期肝癌患者临床资料。23例患者,男15例,女8例,年龄为(62±9)岁。肿瘤疗效根据改良实体肿瘤评价标准进行评价,并分析治疗后相关不良事件。结果所有患者均接受过(2.6±1.0)次的D-TACE治疗,TACE抵抗7例,远处转移6例。联合治疗后1和3个月疾病缓解率(ORR)分别是47.8%和60.9%,疾病控制率(DCR)分别是73.9%和78.3%;中位无进展生存期(mPFS)为126 d。入组时18例甲胎蛋白(AFP)>200μg/L患者中,治疗前和治疗后2个月分别为(497±117)μg/L和(80±19)μg/L,差异有统计学意义(P<0.05);9例血清血管内皮生长因子(VEGF)>142.2 ng/L患者中,治疗前和治疗后2个月分别为(154±51)ng/L和(57±19)ng/L,差异有统计学意义(P<0.05)。联合治疗相关的不良事件发生率为87.0%(20/23),所有不良反应均未超过3级且可通过对症支持治疗或调整阿帕替尼的服药方式得到控制,其中治疗后3个月天冬氨酸转氨酶(AST)水平较治疗前升高[(77±33)U/L比(45±26)U/L,P<0.05]。结论对于中晚期肝癌D-TACE治疗后进展的患者,应用卡瑞利珠单抗联合阿帕替尼治疗的疗效确切、不良反应可控。Objective To explore the preliminary clinical efficacy and safety of calerizumab combined with apatinib in the treatment of patients with middle-advanced liver cancer whose disease has progressed after drug-eluting beads-transcatheter arterial chemoembolization(D-TACE).Methods A retrospective analysis of 23 patients with advanced liver cancer after D-TACE who were treated with carrelizumab combined with apatinib from April 2019 to July 2020 at Lianyungang First People′s Hospital was carried out.There were 15 males and 8 females with a mean age of(62±9)years.The clinical efficacy was evaluated according to the modified Response Evaluation Criteria in Solid Tumors(mRECRST),and treatment-related adverse events were analyzed after treatment.Results All the patients received D-TACE therapy with an average of(2.6±1.0)times,TACE-refractory tumor was observed in 7 patients,and distant metastasis was seen in 6 patients.The objective response rates after combined treatment of 1 month and 3 months were 47.8%and 60.9%,respectively.Disease control rate(DCR)was 73.9%and 78.3%,respectively;median progression-free survival(mPFS)was 126 days.Among 18 patients with alpha fatoprotein(AFP)>200μg/L,the values before and after treatment of 2 months was(497±117)μg/L and(80±19)μg/L,respectively(P<0.05).Among 9 patients of vascular endothelial growth factor(VEGF)>142.2 ng/L,the values before and after treatment of 2 months was(154±51)ng/L and(57±19)ng/L,respectively(P<0.05).The incidence of treatment-related adverse events was 87.0%(20/23).All adverse reactions did not exceed grade 3 and could be controlled by symptomatic supportive treatment or reducing the dose of apatinib,and the serum aspartate aminotransferase(AST)level after treatment of 3 months[(77±33)U/L]was higher than that before treatment[(45±26)U/L](P<0.05).Conclusion For patients with advanced liver cancer after D-TACE,the treatment of carrelizumab combined with apatinib is effective and the adverse reactions are controllable.

关 键 词：肝肿瘤 中晚期肝癌 卡瑞利珠单抗 阿帕替尼 肝动脉化疗栓塞术 

分 类 号：R735.7[医药卫生—肿瘤]