免疫检查点抑制剂联合抗血管生成药物治疗晚期非小细胞肺癌的临床疗效与安全性  

Efficacy and Safety of Immune Checkpoint Inhibitors Combined with Anti-angiogenesis Therapy for Patients with Advanced Non-small Cell Lung Cancer

作　　者：金瑶 翁一鸣[1] 魏家燕 彭敏[1] JIN Yao;WENG Yi-ming;WEI Jia-yan;PENG Min(Cancer Center,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肿瘤中心,湖北武汉430060

出　　处：《肿瘤学杂志》2021年第9期716-721,共6页Journal of Chinese Oncology

摘　　要：[目的]探讨免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)联合抗血管生成药物在晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者治疗中的疗效及安全性。[方法]收集61例符合条件的晚期NSCLC患者,观察其客观缓解率(objective response,ORR)、无进展生存期(progression-free survival,PFS)及不良反应等。[结果]纳入研究患者ORR为45.9%,中位PFS为7.9个月(95%CI:6.38~9.41)。亚组分析显示,与后线治疗组相比,一线治疗组患者不仅ORR具有显著性差异(χ^(2)=9.300,P=0.010),PFS也得到了显著性改善(χ^(2)=8.993,P=0.011)。联合化疗组患者与未联合化疗组患者相比,ORR和PFS均无统计学差异(ORR:χ^(2)=0.006,P=0.939;PFS:χ^(2)=0.350,P=0.554)。联合化疗组血液毒性及消化道不良反应的发生率显著性高于未联合化疗组(χ^(2)=4.725,P=0.030;χ^(2)=4.750,P=0.029)。ICIs联合不同种类的抗血管生成药物的PFS无显著性差异(χ^(2)=2.258,P=0.323)。[结论]ICIs联合抗血管生成药物治疗晚期NSCLC具有较好的疗效,且耐受性可。临床实践中,ICIs前线联合抗血管生成药物患者获益可能更加明显,且无论联合哪类抗血管生成药物均能延长患者PFS。联合化疗对患者PFS并无显著性改善,这为晚期NSCLC患者"去化疗"带来了新的希望。[Objective]To explore the efficacy and safety of immune checkpoint inhibitors(ICIs)combined with anti-angiogenesis therapy for patients with advanced non-small cell lung cancer(NSCLC).[Methods]The objective response rate(ORR),progression-free survival(PFS)and adverse events were observed in 61 eligible patients with advanced NSCLC.[Results]The ORR was 45.9%,and the median PFS was 7.9 months(95%CI:6.38~9.41).The subgroup analysis revealed a significant difference in ORR(χ^(2)=9.300,P=0.010)and PFS(χ^(2)=8.993,P=0.011)for patients receiving first-line treatment vs other lines.There was no significant difference in ORR(χ^(2)=0.006,P=0.939)and PFS(χ^(2)=0.350,P=0.554)between the combined chemotherapy group and the non-combined chemotherapy group.However,the incidence of blood toxicity and gastrointestinal side effects in the combined chemotherapy group was significantly higher than that in the non-combined chemotherapy group(χ^(2)=4.725,P=0.030;χ^(2)=4.750,P=0.029).In addition,there was no significant difference in PFS among patients receiving ICIs combined with different kinds of anti-angiogenic drugs(χ^(2)=2.258,P=0.323).[Conclusion]Immune checkpoint inhibitors combined with anti-angiogenic drugs in the treatment of advanced NSCLC has good efficacy with mild side effects.The patients with front-line ICIs combined with anti-angiogenic drugs may benefit more significantly,and no matter which type of anti-angiogenic drugs are combined,they can prolong PFS.In addition,we also found that combined chemotherapy did not significantly improve the PFS,which brings new hope for patients with advanced NSCLC to“de-chemotherapy”.

关 键 词：非小细胞肺癌 免疫检查点抑制剂 抗血管生成 疗效 

分 类 号：R734.2[医药卫生—肿瘤]