免疫检查点抑制剂联合抗血管生成药物治疗非小细胞肺癌的疗效和安全性  

Efficacy and safety of immune checkpoint inhibitors combined with anti-angiogenic agents in the treatment of non-small cell lung cancer

作　　者：宋佳烨 季进锋[2] 曹永峰[1] 龚军[1] SONG Jia-ye;JI Jin-feng;CAO Yong-feng(Department of Medical Oncology,Nantong Tumor Hospital,Nantong Jiangsu 226361,China;Department of Integrated Traditional Chinese and Western Medicine,Nantong Tumor Hospital,Nantong Jiangsu 226361,China)

机构地区：[1]南通市肿瘤医院肿瘤内科,江苏南通226361 [2]南通市肿瘤医院中西医结合科,江苏南通226361

出　　处：《临床和实验医学杂志》2023年第22期2376-2380,共5页Journal of Clinical and Experimental Medicine

基　　金：江苏省中医药科技发展计划项目(编号:YB2020067)。

摘　　要：目的分析免疫检查点抑制剂联合抗血管生成药物治疗非小细胞肺癌的疗效和安全性。方法选择自2020年6月至2021年6月南通市肿瘤医院收治的68例非小细胞肺癌患者作为研究对象,依据随机数字表法分为观察组和对照组,各34例。对照组予以常规化疗(培美曲塞联合卡铂),观察组予以免疫检查点抑制剂联合抗血管生成药物治疗(卡瑞利珠单抗联合贝伐珠单抗注射液),1个治疗周期为21 d,至少治疗2个周期。随访18个月,比较两组治疗前后血清血管内皮生长因子(VEGF)水平、T淋巴细胞亚群水平(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、生活质量总体改善率、治疗效果及预后、不良反应发生情况。结果治疗后,观察组血清VEGF水平为(114.02±13.44)ng/L,低于对照组[(153.97±17.85)ng/L],差异有统计学意义(P<0.05)。治疗后,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均较治疗前升高,CD8^(+)较治疗前降低,且观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平分别为(68.82±8.64)%、(35.35±8.97)%、2.49±0.85,均高于对照组[(64.32±8.02)%、(30.69±7.73)%、2.05±0.83],观察组CD8^(+)为(21.61±3.52)%,低于对照组[(25.01±6.53)%],差异均有统计学意义(P<0.05)。观察组治疗后生活质量总体改善率为61.76%,高于对照组的35.29%,差异均有统计学意义(P<0.05)。观察组的客观缓解率(ORR)、疾病控制率(DCR)为44.125%、85.29%,均高于对照组(20.59%、61.76%),中位无进展生存期(PFS)和中位总生存期(OS)6.64、13.89个月,均长于对照组(5.13、10.74个月),差异均有统计学意义(P<0.05)。两组均无不良反应相关死亡发生,在Ⅲ~Ⅳ级的血液性毒性、胃肠反应、肝功能异常、肾功能异常、乏力、皮疹上比较差异无统计学意义(P>0.05)。结论免疫检查点抑制剂联合抗血管生成药物治疗非小细胞肺癌的疗效明确,安全性较高,有利于免疫功能的恢复,提高生活质量,值得进一步研究应用。Objective To analyze the efficacy and safety of immune checkpoint inhibitors combined with anti-angiogenic agents in the treatment of non-small cell lung cancer.Methods Sixty-eight patients with non-small cell lung cancer admitted to Nantong Tumor Hospital from June 2020 to June 2021 were selected as the study objects,and were divided into observation group and control group according to random number table method,with 34 cases in each group.The control group received routine chemotherapy(pemetrexed combined with carboplatin),while the observation group received immune checkpoint inhibitors combined with anti angiogenic drugs(carbalizumab combined with bevacizumab injection).One treatment cycle was 21 days,with at least two treatment cycles.After 18 months of follow-up,the level of serum vascular endothelial growth factor(VEGF),the levels of T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),the overall improvement rate of quality of life,the treatment effect and prognosis,and the occurrence of adverse reactions were compared between the two groups before and after treatment.Results After treatment,the level of serum VEGF in the observation group was(114.02±13.44)ng/L,which was lower than that in the control group[(153.97±17.85)ng/L],the difference was statistically significant(P<0.05).The levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the observation group were(68.82±8.64)%,(35.35±8.97)%,and 2.49±0.85,respectively,which were higher than those in the control group[64.32±8.02)%,(30.69±7.73)%,and 2.05±0.83],and CD8^(+)was(21.61±3.52)%in the observation group,which was lower than that in the control group[25.01±6.53)%],the differences were statistically significant(P<0.05).The overall improvement rate of quality of life in the observation group was 61.76%,which was higher than that in the control group(35.29%),the difference was statistically significant(P<0.05).The objective response rate(ORR)and disease control rate(DCR)in observation group were 44.125%,85.29%,which were higher than those in

关 键 词：非小细胞肺癌 免疫检查点抑制剂 抗血管生成药物 疗效 安全性 

分 类 号：R734.2[医药卫生—肿瘤]