免疫跨线联合安罗替尼三线治疗晚期非小细胞肺癌近远期疗效观察  

Observation on the short and long term efficacy of immune cross line therapy combined with anlotinib in the treatment of advanced non-small cell lung cancer

作　　者：齐心 刘佳 封元清 杜娟 任彦玲 Qi Xin;Liu Jia;Feng Yuanqing;Du Juan;Ren Yanling(Department of Oncology,Xiangtan Central Hospital,Hunan,Xiangtan 411100,China)

机构地区：[1]湘潭市中心医院肿瘤一科,湖南湘潭411100

出　　处：《肿瘤综合治疗电子杂志》2023年第3期93-97,共5页Journal of Multidisciplinary Cancer Management(Electronic Version)

基　　金：湖南省卫生健康委2023年度科研计划课题一般课题(D202303109313)。

摘　　要：目的探讨免疫跨线联合安罗替尼三线治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)近远期疗效。方法选择2019年1月至2022年8月湘潭市中心医院收治的90例晚期NSCLC患者为研究对象,采用随机数字表法将其分为观察组和对照组,每组各45例。对照组患者口服安罗替尼,观察组患者选择原二线治疗阶段使用的程序性死亡蛋白-1(programmed cell death protein 1,PD-1)免疫治疗药物跨线并联合安罗替尼,PD-1免疫治疗药物分别包括卡瑞利珠单抗或信迪利单抗或帕博利珠单抗。两组均以21 d为1个周期,治疗2个周期评价疗效。比较两组患者近期疗效,治疗前后生存质量,癌胚抗原(carcinoembryonic antigen,CEA)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)和血管内皮生长因子(vascular endothelial growth factor,VEGF)水平,T淋巴细胞亚群水平变化,不良反应发生情况和无进展生存(progression-free survival,PFS)时间。结果观察组患者治疗总有效率显著高于对照组(P<0.05)。两组患者治疗后卡氏功能状态(Karnofsky performance status,KPS)评分、CD4+T淋巴细胞水平和CD4+T淋巴细胞/CD8+T淋巴细胞比值均显著高于本组治疗前(均P<0.05),血清CEA、NSE和VEGF水平,以及CD8+T淋巴细胞水平均显著低于本组治疗前(均P<0.05);观察组患者治疗后KPS评分、CD4+T淋巴细胞水平和CD4+T淋巴细胞/CD8+T淋巴细胞比值均显著高于对照组(均P<0.05),血清CEA、NSE和VEGF水平及CD8+T淋巴细胞水平均显著低于对照组(均P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。观察组患者PFS时间显著长于对照组(P<0.05)。结论免疫跨线联合安罗替尼三线治疗晚期NSCLC患者近期疗效良好,患者生存质量显著提高,血清CEA、NSE和VEGF水平显著降低,免疫功能显著提高,且可延长患者PFS时间。Objective To observe the short and long term efficacy of immune cross line therapy combined with anlotinib in the treatment of advanced non-small cell lung cancer(NSCLC).Method Ninety patients with advanced NSCLC admitted to Xiangtan Central Hospital from January 2019 to August 2022 were divided into observation group and control group,with 45 cases in each group,according to the random number table method.Control group patients received oral administration of anlotinib,observation group patients selected the programmed death protein-1(PD-1)immunotherapy drug used in the original second line treatment stage to cross the line and combine with anlotinib.The PD-1 immunotherapy drugs included camrelizumab or sintilimab or pembrolizumab,respectively.Two groups were evaluated for a period of 21 days and 2 treatment cycles.The short-term efficacy,quality of life,changes in levels of carcinoembryonic antigen(CEA),neuron specific enolase(NSE),vascular endothelial growth factor(VEGF),and T lymphocyte subsets before and after treatment;adverse reactions and progression-free survival(PFS)between the two groups were compared.Result The total effective rate in observation group was significantly higher than that in control group(P<0.05).The KPS scores,CD4+T lymphocyte levels and CD4+T lymphocyte/CD8+T lymphocyte ratios in both groups after treatment were significantly higher than those before treatment(all P<0.05),while serum CEA,NSE and VEGF levels and CD8+T lymphocyte levels were significantly lower than those before treatment(all P<0.05).After treatment,the KPS score,CD4+T lymphocyte level and CD4+T lymphocyte/CD8+T lymphocyte ratio in observation group were significantly higher than those in control group(all P<0.05),while serum CEA,NSE and VEGF levels and CD8+T lymphocyte levels were significantly lower than those in control group(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).PFS time in observation group was significantly longer than that in control g

关 键 词：晚期非小细胞肺癌 免疫跨线 安罗替尼 

分 类 号：R734.2[医药卫生—肿瘤]