经肝动脉化疗栓塞+仑伐替尼+PD-1单抗在中晚期不可切除肝癌转化切除中的安全性和有效性的前瞻性队列研究:初步报告  

The safety and efficacy of transarterial chemoembolization + lenvatinib + PD-1 antibody in the conversion resection for intermediate and advanced unresectable hepatocellular carcinoma: a prospective cohort study and preliminary report

作　　者：张晓赟[1] 朱心睿 彭伟[1] 刘畅[1] 李川[1] 李秋[2] 陈卫霞[3] 李志平[4] 卢强[5] 卢武胜[1] 严律南[1] 杨家印[1] 文天夫[1] ZHANG Xiaoyun;ZHU Xinrui;PENG Wei;LIU Chang;LI Chuan;LI Qiu;CHEN Weixia;LI Zhiping;LU Qiang;LU Wusheng;YAN Lünan;YANG Jiayin;WEN Tianfu(Department of Liver Surgery/Liver Transplantation Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Medical Oncology,Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Radiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Abdominal Radiotherapy,Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Ultrasound,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院肝脏外科/肝移植中心,成都610041 [2]四川大学华西医院肿瘤中心腹部肿瘤科,成都610041 [3]四川大学华西医院放射科,成都610041 [4]四川大学华西医院肿瘤中心腹部放疗科,成都610041 [5]四川大学华西医院超声科,成都610041

出　　处：《中国普外基础与临床杂志》2022年第1期39-45,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省重点研发项目(项目编号:2020YFS0133、22ZDYF0662);四川大学华西医院专职博士后研发基金(项目编号:2019HXBH004)。

摘　　要：目的探讨经肝动脉化疗栓塞(TACE)联合仑伐替尼及程序性死亡受体-1(PD-1)单抗在中晚期肝细胞肝癌(HCC)转化切除中的安全性和有效性,探索中晚期HCC治疗的新治疗策略。方法本研究前瞻性纳入2020年10月至2021年6月期间四川大学华西医院肝脏外科收治的符合纳入标准的患者38例,给予TACE+仑伐替尼+PD-1单抗治疗,总结该38例患者的治疗效果。结果本组38例患者的末次评估时间为2021年10月20日。根据mRECIST标准进行肿瘤疗效评估,客观缓解率为84.2%(32/38),疾病控制率为94.7%(36/38);以影像为基础的转化成功率为55.3%(21/38),实际的转化切除率为52.6%(20/38)。不良事件发生率为100%,其中22例发生3级不良事件,无4级及以上不良事件发生。所有患者均获访,随访时间16~52周,中位随访时间为33.5周。随访期间仅2例患者肿瘤进展,其中1例患者因肿瘤进展死亡,无术后复发患者。结论 TACE联合仑伐替尼及PD-1单抗治疗中晚期HCC比较安全,可取得较高的转化切除成功率,这将为中晚期HCC提供一种新的治疗策略。Objective To explore the safety and effectiveness of transarterial chemoembolization(TACE)combined with lenvatinib and programmed cell death protein-1(PD-1) antibody in the conversion resection for intermediate and advanced unresectable hepatocellular carcinoma(HCC), and to provide new treatment strategies for the treatment of intermediate and advanced unresectable HCC. Method Thirty-eight intermediate and advanced unresectable HCC patients treated at West China Hospital of Sichuan University from October 2020 to June 2021 were prospectively included in our study, all patients treated with TACE + lenvatinib + PD-1 antibody, and the clinical data of these 38 patients were summarized. Results The last evaluation time for the 38 patients was October 20, 2021. According to the mRECIST standard for tumor efficacy evaluation, the objective response rate was 84.2%(32/38), the disease control rate was 94.7%(36/38);the conversion success rate based on imaging was 55.3%(21/38), the actual conversion resection rate was 52.6%(20/38). The incidence of adverse events was 100%, of which 22 patients had grade 3 adverse events, and there was no ≥ grade 4 adverse events. All patients were followed up, the follow-up time was 16–52 weeks, and the median follow-up time was 33.5 weeks. During the follow-up period, only two patients had tumor progression, of which one patient died due to disease progression, and there was no postoperative recurrence. Conclusions Lenvatinib combined with TACE and PD-1 antibody is safe for the treatment of intermediate and advanced unresectable HCC. Triple therapy can achieve satisfactory conversion resection rate of intermediate and advanced unresectable HCC,which will provide a new treatment strategy for it.

关 键 词：中晚期肝细胞肝癌 转化治疗 仑伐替尼 经肝动脉化疗栓塞 程序性死亡受体-1单抗 

分 类 号：R735.7[医药卫生—肿瘤]