卡瑞利珠单抗联合化疗治疗非小细胞肺癌脑转移的疗效和安全性  

Efficacy and safety of camrelizumab combined with chemotherapy in the treatment of non-small cell lung cancer with brain metastases

作　　者：李燚 常志伟[1] 闫洁[1] 王文佳 秦艳茹[1] LI Yi;CHANG Zhiwei;YAN Jie;WANG Wenjia;QIN Yanru(Department of Oncology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肿瘤科,河南郑州450052

出　　处：《肿瘤基础与临床》2022年第2期113-118,共6页journal of basic and clinical oncology

基　　金：国家自然科学基金资助项目(81872264)。

摘　　要：目的评价卡瑞利珠单抗联合化疗治疗非小细胞肺癌(NSCLC)脑转移患者的疗效和安全性。方法收集42例经卡瑞利珠单抗联合化疗一线治疗的不可手术NSCLC脑转移患者的临床病理资料,确认疗效和疾病进展时间,以不良事件发生率评估联合治疗的安全性和耐受性。结果42例患者可进行疗效评价。脑转移瘤病灶的疗效分析中,客观缓解率(ORR)为35.7%,疾病控制率(DCR)为76.2%。颅外病变的疗效评价中,ORR为38.1%,DCR为61.9%。中位疾病无进展生存期(PFS)为12.6个月。单因素生存分析发现,性别(χ^(2)=6.372,P=0.012)、程序性死亡配体1表达量(χ^(2)=3.915,P=0.048)、转移器官个数(χ^(2)=4.866,P=0.027)、中性粒细胞-淋巴细胞比值治疗前后差异(χ^(2)=9.846,P=0.002)与PFS相关。多因素COX回归分析发现,性别(P=0.014)、PD-L1表达量(P=0.044)、治疗前后NLR的差异(P=0.005)为PFS的独立危险因素。可观察到的大部分不良事件为Ⅰ、Ⅱ度。未观察到致命性不良事件。Ⅲ、Ⅳ度不良反应分别为中性粒细胞减少5例(11.9%)、血小板减少4例(9.5%)、肺炎2例(4.8%)、肝功能异常1例(2.4%)、皮疹1例(2.4%)。结论卡瑞利珠单抗联合化疗在治疗NSCLC脑转移患者中表现出了良好的疗效和安全性。Objective To evaluate the efficacy and safety of camrelizumab combined with chemotherapy in the treatment of non-small cell lung cancer(NSCLC)patients with brain metastases.Methods All the 42 NSCLC patients with inoperable brain metastases who received chemotherapy combined with camrelizumab as first-line treatment were reviewed.The efficacy of the treatment was assessed by the tumor response and survival.The safety and tolerability of the combination treatment were assessed by the incidence of adverse events.Results The 42 NSCLC patients with brain metastases who received camrelizumab combined with chemotherapy gained a median progress-free survival(PFS)of 12.6 months.In the efficacy of brain metastases,the overall response rate(ORR)was 35.7%and the disease control rate(DCR)was 76.2%.In the efficacy of extracranial lesions,the ORR was 38.1%and the DCR was 61.9%.In exploratory analyses,gender(χ^(2)=6.372,P=0.012),programmed death-ligand 1 expression quantity(χ^(2)=3.915,P=0.048),metastatic sites(χ^(2)=4.866,P=0.027)and the difference of neutrophil lymphocyte ratio before and after treatment(χ^(2)=9.846,P=0.002)were associated with PFS.Multivariate Cox regression analysis showed that gender(P=0.014),PD-L1 expression(P=0.044)and NLR difference before and after treatment(P=0.005)were independent risk factors for PFS.Most of these observed adverse events were gradeⅠorⅡ.There were no fatal adverse events observed.These gradeⅢorⅣadverse events were neutropenia(5 patients,11.9%),thrombocytopenia(4 patients,9.5%),pneumonitis(2 patients,4.8%),hepatic function abnormal(1 patient,2.4%),rash(1 patients,2.4%).Conclusion Camrelizumab combined with chemotherapy demonstrate a great activity as well as a good safety profile in managing the NSCLC patients with brain metastases.

关 键 词：非小细胞肺癌 脑转移 卡瑞利珠单抗 化疗 免疫治疗 

分 类 号：R734.2[医药卫生—肿瘤]