循证建立PD-1抑制剂用于食管癌的药物治疗路径  

To Explore the Medication Pathway of PD-1 Inhibitors for Esophageal Cancer-Based Evidence

作　　者：占美[1,2] 郑寒蕊 卢静[3] ZHAN Mei;ZHENG Hanrui;LU Jing(Department of Pharmacy,West China Hospital,Sichuan University,Chengdu 610041,China;West China Pharmacy of Sichuan University,Chengdu 610041,China;Department of Medical Insurance,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院药剂科,成都610041 [2]四川大学华西药学院,成都610041 [3]四川大学华西医院医保办公室,成都610041

出　　处：《医药导报》2022年第12期1864-1870,共7页Herald of Medicine

摘　　要：目的建立程序性死亡(PD)-1抑制剂用于食管癌的药学路径。方法检索中国、美国和欧洲肿瘤学会收集食管癌治疗指南,整理指南推荐可以用于食管癌的PD-1抑制剂的内容。如果指南同时推荐了多种PD-1抑制剂用于同一类患者的治疗,则采用美国临床肿瘤学会(ASCO)发布的价值框架对PD-1抑制剂进行价值评价,并通过文献检索法收集药物经济学研究,综合指南推荐,价值评价结果和成本-效用分析结果,基于药品的疗效,安全性和经济性,初步建立药学路径。结果中国和美国指南同时推荐帕博利珠单抗、纳武利尤单抗和卡瑞利珠单抗用于晚期食管鳞癌的二线治疗。价值评分最高的是卡瑞利珠单抗,药物经济学研究显示对比化疗,只有卡瑞利单抗二线治疗食管癌有经济性。结论PD-1抑制剂用于晚期食管癌二线治疗,指南推荐强度最大,证据最充分,卡瑞利珠单抗最具性价比,故作为药学路径中的优选方案。Objective To establish the pharmaceutical pathway of PD-1 inhibitor for esophageal cancer-based evidence.Methods Search the guidelines of esophageal cancer by Chinese,American,and European societies of clinical oncology,and sort out the PD-1 inhibitors recommended by guidelines.If the guidelines recommend more than one PD-1 inhibitor for the treatment of the same population,the American Society of Clinical Oncology(ASCO)framework was used to evaluate the value of PD-1 inhibitors,the pharmacoeconomic research was collected by literature search based on the efficacy,safety and economy of drugs,a pharmaceutical pathway was preliminarily established.Results The guidelines recommended that pembrolizumab,nivolumab and camrelizumab could be used in the second-line treatment of advanced esophageal squamous cell carcinoma.The highest value score is camrelizumab.Pharmacoeconomic studies show that compared with chemotherapy,only camrelizumab is cost-effective in the second-line treatment of esophageal cancer.Conclusion Camrelizumab is the most cost-effective for the second-line treatment of advanced esophageal cancer,so it is the preferred treatment in the pharmaceutical path.

关 键 词：PD-1抑制剂 食管癌 指南 价值 成本-效用分析 

分 类 号：R979.1[医药卫生—药品] R956[医药卫生—药学]