PD-1抑制剂联合一线化疗方案对晚期驱动基因阴性肺腺癌的效果及安全性分析  

Analysis of the efficacy and safety of PD-1 inhibitor combined with first-line chemotherapy on advanced lung adenocarcinomas with negative driver gene mutations

作　　者：陈艳妮 张建红[1] 李健[1] 李瑶 逯震芳 陈亮[1] CHEN Yanni;ZHANG Jianhong;LI Jian(Department of Respiratory and Critical Care Medicine,Beijing Jingmei Group General Hospital,Beijing 102399,China)

机构地区：[1]北京京煤集团总医院呼吸与危重症医学科,北京市102399

出　　处：《河北医药》2024年第8期1184-1187,共4页Hebei Medical Journal

基　　金：北京京煤集团总医院院级科研自主项目(编号:ZZ2022-07)。

摘　　要：目的探讨程序性细胞死亡蛋白-1(PD-1)抑制剂联合一线化疗方案治疗晚期驱动基因阴性肺腺癌的效果及安全性。方法回顾性收集2019年1月至2021年12月收治的60例晚期驱动基因阴性的肺腺癌患者病历资料,依据治疗方式不同分组,将30例接受培美曲塞、顺铂联合PD-1抑制剂(信迪利单抗)治疗的病历资料纳入观察组另30例接受培美曲塞联合顺铂治疗的病历资料纳入对照组。对比2组患者治疗前、治疗30 d时2组临床疗效[客观缓解率(ORR)、疾病控制率(DCR)]、免疫功能[CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)]、肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)]、不良反应[恶心、粒细胞减少、肝功能异常、甲状腺功能异常、肺炎、皮疹、血小板降低]。结果观察组ORR显著高于对照组,差异有统计学意义(P<0.05);2组DCR比较差异无统计学意义(P>0.05);治疗后,观察组CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平高于治疗前,且高于对照组(P<0.05);治疗后,2组CYFRA21-1、CEA水平均下降,且观察组低于对照组(P<0.05)。观察组甲状腺功能异常、肺炎、皮疹等发生例数显著多于对照组,差异有统计学意义(P<0.05)。结论PD-1抑制剂联合化疗一线治疗可有效改善晚期驱动基因阴性肺腺癌患者免疫功能,并降低肿瘤标志物水平,疗效确切。Objective To investigate the efficacy and safety of programmed cell death protein 1(PD-1)inhibitor combined with first-line chemotherapy on advanced lung adenocarcinomas with negative driver gene mutations.Methods Medical records of 60 patients with advanced lung adenocarcinomas with negative driver gene mutations admitted from January 2019 to December 2021 were retrospectively analyzed.According to different treatment methods,30 patients receiving pemetrexed combined with cisplatin were included in the control group,and 30 receiving pemetrexed,cisplatin combined with PD-1 inhibitor(Sintilimab)were included in the observation group.Clinical efficacy before treatment and at 30 days of treatment,including the objective response rate(ORR)and disease control rate(DCR)were compared between groups.Immune function indicators,including CD_(4)^(+) T cells,CD_(8)^(+) T cells and CD_(4)^(+)/CD_(8)^(+) ratio were compared.Tumor markers,including carcinoembryonic antigen(CEA)and cytokeratin 19 fragment(CYFRA21-1)were compared.The incidence of adverse events,including nausea,granulocytopenia,abnormal liver function,thyroid dysfunction,pneumonia,rash and thrombocytopenia was compared.Results The ORR of the observation group was significantly higher than that of the control group(P<0.05).There was no significant difference in DCR between the two groups(P>0.05).After treatment,CD_(4)^(+) T cells,CD_(8)^(+) T cells and CD_(4)^(+)/CD_(8)^(+) ratio in the observation group were significantly higher than before treatment and higher than that of the control group(P<0.05).After treatment,the levels of CYFRA21-1 and CEA in both groups decreased,which were significantly lower in the observation group than those of the control group(P<0.05).Case number of adverse events like thyroid dysfunction,pneumonia and rash was significantly greater in the observation group than that of the control group(P<0.05).Conclusion PD-1 inhibitor combined with first-line chemotherapy can effectively improve the immune function and lower tumor markers with a

关 键 词：肺腺癌 驱动基因阴性 PD-1抑制剂 化疗 免疫功能 

分 类 号：R734.2[医药卫生—肿瘤]