卡瑞利珠单抗挽救性治疗移植肝组织PD-L1阴性肝外复发性肝癌  

Camrelizumab salvage therapy for extrahepatic recurrent hepatocellular carcinoma with PD-L1 negativity in transplanted liver tissue

作　　者：邓宜南 汪国营[1] 王建丰 范林达 张英才[1] 张彤[1] 易述红[1] 张剑[1] 李华[1] 杨扬[1] Deng Yinan;Wang Guoying;Wang Jianfeng;Fan Linda;Zhang Yingcai;Zhang Tong;Yi Xuhong;Zhang Jian;Li Hua;Yang Yang(Liver Surgery and Liver Transplantation Center,The Third Affiliated Hospital of Sun Yat-sen University,Sun Yat-sen University Organ Transplantation Institute,Guangdong Provincial Organ Transplantation Research Center,Guangdong Provincial Transplantation Medical Engineering Laboratory,Guangdong Provincial Key Laboratory of Liver Diseases,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院肝脏外科暨肝移植中心,中山大学器官移植研究所,广东省器官移植研究中心,广东省移植医学工程实验室,广东省重点肝脏疾病实验室,广州510630

出　　处：《中华器官移植杂志》2022年第5期276-280,共5页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金 (81972286)。

摘　　要：目的探讨卡瑞利珠单抗(Camrelizumab)挽救性治疗移植肝组织PD-L1阴性肝移植术后肝外复发性肝癌的安全性和有效性。方法回顾性分析中山大学附属第三医院2020年5月至2020年12月收治的3例卡瑞利珠单抗挽救性治疗移植肝组织PD-L1阴性肝移植术后肝外复发性肝癌受者的临床资料。此3例肝外复发受者经一线和二线靶向药物治疗后,肿瘤出现进展。免疫组织化学检测证实移植肝正常组织PD-L1阴性后,给予卡瑞利珠单抗进行挽救性治疗。通过监测3例治疗前后丙氨酸转氨酶、天冬氨酸转氨酶及总胆红素水平变化,并发症发生情况和治疗结局探讨治疗的安全性及有效性。结果随访时间为1.5~15.5个月,无受者出现转氨酶和总胆红素急剧升高等急性排斥反应表现。出现头痛1例,呕吐1例,出现乏力和高血压1例,上述症状均经治疗后缓解。截至2022年2月28日,3例受者中,死于肿瘤进展1例,死于食管穿孔所致胸主动脉破裂出血1例,存活1例。受者生存时间为11.0~15.5个月,无进展生存时间为4~6个月。结论移植肝正常组织PD-L1阴性肝移植术后肝外复发性肝癌受者使用卡瑞利珠单抗挽救性治疗,可能可在一定程度上控制肿瘤进展,延长受者生存时间。Objective To explore the safety and efficacy of camrelizumab salvage therapy for extrahepatic recurrent hepatocellular carcinoma with PD-L1 negativity in transplanted liver tissue.Methods From May 2020 to December 2020,retrospective analysis was performed for 3 cases of camrelizumab salvage therapy for extrahepatic recurrent hepatocellular carcinoma recipients with PD-L1 negative in transplanted liver tissue.Three recipients with extrahepatic recurrence progressed after first/second-line targeted drug therapy.Camrelizumab was given as salvage therapy after normal tissue of ransplanted liver was confirmed as negative for PD-L1 by immunohistochemistry.The safety and efficacy of treatment were observed by monitoring the changes in the levels of alanine aminotransferase,aspartate aminotransferase and bilirubin,the occurrence of complications and the outcome of treatment before and after dosing.Results During a follow-up period of 1.5 to 15.5 months,no recipients showed acute rejection symptoms such as sharp elevations of transaminase and bilirubin.Headache(n=1),vomiting(n=1)and fatigue&hypertension(n=1)became relieved after treatment.As of February 28,2022,there were one survivor and two deaths.The fatal causes were tumor progression(n=1)and thoracic aortic rupture due to esophageal perforation(n=1).The survival time of recipients was(11-15.5)months and the progression-free survival time(4-6)months.Conclusions For extrahepatic recurrent hepatocellular carcinoma with PD-L1-negative liver transplantation in normal liver tissue,camrelizumab salvage therapy can control tumor progression to a certain extent and prolong the survival time of recipients.

关 键 词：肝移植 肝癌 卡瑞利珠单抗 

分 类 号：R735.7[医药卫生—肿瘤]