化疗联合程序性死亡受体1抑制剂新辅助治疗局部晚期食管鳞状细胞癌的疗效  

Efficacy of chemotherapy combined with programmed cell death 1 inhibitor neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma

作　　者：李芬芬 肖晓敏[1] LI Fenfen;XIAO Xiaomin(Department of Oncology,Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine,Nanchang 330000,Jiangxi,China)

机构地区：[1]江西中医药大学附属医院肿瘤科,南昌330000

出　　处：《癌症进展》2023年第1期66-70,74,共6页Oncology Progress

摘　　要：目的探讨白蛋白紫杉醇、卡铂化疗联合程序性死亡受体1(PD-1)抑制剂新辅助治疗局部晚期食管鳞状细胞癌的疗效。方法选取21例局部晚期食管鳞状细胞癌患者,术前给予白蛋白紫杉醇+卡铂+卡瑞利珠单抗三联新辅助治疗,主要研究终点为病理学完全缓解(pCR)率,次要终点为R0切除率和安全性。结果21患者均完成了2~4个周期的治疗,18例患者新辅助治疗后4~6周内进行食管癌根治性切除术,3例患者新辅助治疗后拒绝行手术。对21例患者进行临床疗效评价,18例患者均有不同程度的肿瘤缩小,3例拒绝手术,3例患者病情进展,其中1例患者化疗联合PD-1抑制剂新辅助治疗+手术后病情进展而接受放疗。21例局部中晚期食管鳞状细胞癌患者治疗结束4周后,客观缓解率(ORR)为80.95%,18例患者达到R0切除,R0切除率为85.71%(18/21),其中7例(38.89%)实现pCR。最常见血液学毒性为白细胞减少,占比14.3%,其次为血小板减少和贫血。结论术前白蛋白结合紫杉醇、卡铂、卡瑞利珠单抗三联新辅助治疗方案治疗局部晚期食管鳞状细胞癌患者,肿瘤降期明显,R0切除率高,pCR高,患者对治疗相关毒性的耐受性良好。Objective To investigate the efficacy of albumin-bound paclitaxel,carboplatin chemotherapy combined with programmed cell death 1 inhibitor neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma.Method A total of 21 patients with locally advanced esophageal squamous cell carcinoma were selected and given triple neoadjuvant therapy with albumin-bound paclitaxel+carboplatin+camrelizumab before the surgery.The primary endpoint was the pathologic complete response(pCR)rate,and the secondary endpoint was the R0 resection rate and safety.Result All 21 patients completed 2-4 cycles of treatment.Among them,18 patients underwent radical esophagectomy within 4-6 weeks after neoadjuvant therapy,and 3 patients refused surgery after the neoadjuvant therapy.The clinical curative effect of 21 patients was evaluated,18 of them had different degrees of tumor shrinkage,3 patients refused surgery,and 3 patients had disease progression,among which 1 patient received radiotherapy because of the disease progression after PD-1 inhibitor neoadjuvant therapy plus surgery.After 4 weeks of treatment in 21 patients with locally advanced esophageal squamous cell carcinoma,the objective response rate(ORR)was 80.95%,18 patients achieved R0 resection,and the R0 resection rate was 85.71%(18/21),of which 7 cases(38.89%)achieved pCR.The most common hematological toxicity was leukopenia,accounting for 14.3%,followed by thrombocytopenia and anemia.Conclusion locally advanced esophageal squamous cell carcinoma patients treated with albumin-bound paclitaxel,carboplatin,and camrelizumab triple neoadjuvant pre-operative therapy could achieve obvious tumor downstaging.And the R0 resection rate and the pCR were high.Attentionally,treatment-related toxicities were well-tolerated by patients.

关 键 词：食管鳞状细胞癌 白蛋白结合型紫杉醇 卡铂 卡瑞利珠单抗 病理学完全缓解 

分 类 号：R735.1[医药卫生—肿瘤]