血卟啉介导光动力疗法联合PD-1抑制剂治疗食管癌的临床研究  

Clinical Study on Joint Treatment of Esophageal Cancer with Hematoporphyrin Mediated Photodynamic Therapy and PD-1 Inhibitor

作　　者：张凤鸣[1] 刘慧龙 苏红利[1] 任建鸿[1] 王薇 隗合玉[1] ZHANG Fengming;LIU Huilong;SU Hongli;REN Jianhong;WANG Wei;WEI Heyu(Department of Oncology,Beijing Fengtai Hospital,Beijing 100070,China;Seventh Medical Center of Chinese PLA General Hospital)

机构地区：[1]北京丰台医院肿瘤科,北京市100700 [2]解放军总医院第七医学中心肿瘤科

出　　处：《中国激光医学杂志》2022年第4期188-193,共6页Chinese Journal of Laser Medicine & Surgery

基　　金：国家重点研发计划(2018YFB0407200)。

摘　　要：目的初步评价血卟啉介导光动力疗法(photodynamic therapy,PDT)联合PD-1抑制剂治疗食管癌的近期疗效。方法选择2020年9月至2022年3月,食管癌患者15例,均行PDT联合PD-1抑制剂治疗。其中,光敏药物为血卟啉注射液,给药剂量为4~5 mg/kg,于照光前24~48 h静脉滴注,应用波长630 nm激光进行PDT治疗,功率密度80~200 mW/cm^(2),能量密度80~216 J/cm^(2)。PDT治疗前完成第一次PD-1抑制剂治疗,患者总计接受1~9周期PD-1抑制剂治疗。PD-1抑制剂治疗后进行疗效评价,记录疼痛、发热、呃逆以及白细胞升高等主要不良反应发生情况。结果15例患者治疗后,2例进食无障碍者均完全缓解;4例部分梗阻性食管癌患者中,2例部分缓解、2例基本稳定;9例严重梗阻性食管癌患者中,6例部分缓解,3例基本稳定。所有受试者均未出现皮肤光毒性。1例发生严重不良事件(serious adverse event,SAE)为上消化道出血,判定与本研究采用的治疗可能无关。治疗期间,15例患者中10例出现疼痛、6例出现发热、5例出现呃逆,5例白细胞升高,不良反应发生率为93.3%。结论血卟啉介导PDT联合PD-1抑制剂治疗食管癌安全有效,值得进一步深入研究。Objective To evaluate the efficacy and safety to treat esophageal cancer jointly with hematoporphyrin mediated photodynamic therapy and PD-1 inhibitors.Methods Totally 15 patients with esophageal cancer who failed in,lacked or refused standard treatment were selected.Hematoporphyrin was injected intravenously to the patients 24-48 hours before the illumination in a dosage of 4-5 mg/kg.The patients were then irradiated with 630 nm laser of a power density of 80-200 mW/cm^(2) and an energy density of 80-216 J/cm^(2).The first PD-1 inhibitor treatment was completed before the photodynamic therapy,and 1-9 PD-1 inhibitor treatments were given to the patients in total.The short-term efficacy and adverse reactions were observed and studied.Results After the treatment,2 patients(swallowing index:0)had complete remission(CR).Among the 4 patients with partial obstructive esophageal cancer,2 got partial response(PR)and 2 stable disease(SD).Among the 9 patients of severe obstructive esophageal cancer,6 got PR and 3 SD.None of the patients suffered skin phototoxicity.One case of serious adverse event(SAE)occurred,i.e.,upper gastrointestinal bleeding,which was not related to the treatment.The adverse reactions having an incidence included pain(10/15),fever(6/15),hiccup(5/15)and leucocytois(5/15)and the total incidence of adverse reactions was93.3%.Conclusions The combined treatment of esophageal cancer with Hematoporphyrin mediated photodynamic therapy and PD-1 inhibitors is safe and effective,which is worthy of further study.

关 键 词：光动力疗法 免疫检查点抑制剂 光敏剂 食管癌 激光 

分 类 号：R454.2[医药卫生—治疗学] R735.1[医药卫生—临床医学]