奥沙利铂和多西他赛联合PD-1/PD-L1抑制剂二线治疗驱动基因阴性的Ⅳ期NSCLC的回顾性研究  

Retrospective Study of Oxaliplatin and Docetaxel Combined with PD-1/PD-L1 Inhibitors in Second-Line Treatment of Stage IV Non-Small Cell Lung Cancer with Negative Driver Genes

作　　者：付国霞 李晓华[1] 郭华[1] 李伟铭[1] Fu Guoxia;Li Xiaohua;Guo Hua;Li Weiming(Department of Respiratory Medicine,the Sixth People's Hospital of Chengdu,Chengdu 610051,Sichuan,China)

机构地区：[1]成都市第六人民医院呼吸内科,成都610051

出　　处：《肿瘤预防与治疗》2024年第6期499-504,共6页Journal of Cancer Control And Treatment

摘　　要：目的:探讨奥沙利铂和多西他赛联合程序性死亡受体-1(programmed cell death receptor-1,PD-1)/程序性死亡配体-1(programmed cell death ligand-1,PD-L1)抑制剂二线治疗驱动基因阴性的IV期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效及安全性,以更好的指导临床治疗。方法:回顾性分析2019年1月至2020年12月在我院二线治疗的驱动基因阴性的Ⅳ期NSCLC患者87例,按照二线治疗方式的不同分为PD-1/PD-L1组44例和奥沙利铂+多西他赛+PD-1/PD-L1组43例,研究终点包括客观缓解率(objective response rate,ORR)、疾病控制率(disease control rate,DCR)、总生存期(overall survival,OS)、无进展生存期(progression-free survival,PFS)和安全性。结果:奥沙利铂+多西他赛+PD-1/PD-L1组ORR(4.65%)与PD-1/PD-L1组(2.27%)比较,无统计学意义(χ^(2)=0.370,P=0.761),奥沙利铂+多西他赛+PD-1/PD-L1组DCR明显高于PD-1/PD-L1组(90.70%vs 70.45%;χ^(2)=5.668,P<0.05)。奥沙利铂+多西他赛+PD-1/PD-L1组的OS率、PFS率明显高于PD-1/PD-L1组(46.51%vs 20.45%;χ^(2)=6.645,P<0.05)、(25.58%vs 6.82%;χ^(2)=5.670,P<0.05)。奥沙利铂+多西他赛+PD-1/PD-L1组骨髓抑制Ⅰ~Ⅱ级发生率、骨髓抑制Ⅲ~Ⅳ级发生率明显高于PD-1/PD-L1组(20.93%vs 0.00%;χ^(2)=10.272,P<0.05)、(13.95%vs 0.00%;χ^(2)=6.594,P<0.05)。结论:奥沙利铂和多西他赛联合PD-1/PD-L1抑制剂二线治疗驱动基因阴性的Ⅳ期NSCLC疾病控制效果更佳,可延长生存时间和无进展生存时间,治疗效果和预后更佳,但需要注意不良反应。Objective:To investigate the efficacy of oxaliplatin and docetaxel combined with programmed cell death receptor-1/programmed cell death ligand-1(PD-1/PD-L1)inhibitors as a second-line treatment for stage IV non-small cell lung cancer(NSCLC)with negative driver genes,and study its safety to better guide clinical medication.Methods:A retrospective analysis was conducted on 87 stage IV NSCLC patients with negative driver genes who underwent second-line treatment at our hospital from January 2019 to December 2020.Based on different second-line treatment approaches,the patients were assigned to the PD-1/PD-L1 group(n=44)and the oxaliplatin+docetaxel+PD-1/PD-L1 group(n=43).The study endpoints included objective response rate(ORR),disease control rate(DCR),overall survival(OS),progression-free survival(PFS)and safety.Results:There was no statistically significant difference in the ORR between the oxaliplatin+docetaxel+PD-1/PD-LI group(4.65%)and the PD-1/PD-L1 group(2.27%)(χ^(2)=0.370,P=0.761).DCR in the oxaliplatin+docetaxel+PD-1/PD-LI group(90.70%)was significantly higher than that in the PD-1/PD-L1 group(70.45%)(χ^(2)=5.668,P<0.05).The OS and PFS rates in the oxaliplatin+docetaxel+PD-1/PD-Ll group were significantly higher than those in the PD-1/PD-L1 group(46.51%vs 20.45%,χ^(2)=6.645,P<0.05;25.58%us 6.82%,χ^(2)=5.670,P<0.05).The incidences of grade I~II and χ^(2)grade II~IV bone marrow suppression in the oxaliplatin+docetaxel+PD-1/PD-L1 group were significantly higher than those in the PD-1/PDLl group(20.93%us 0.00%,χ^(2)=10.272,P<0.05;13.95%us 0.00%,χ^(2)=6.594,P<0.05).Conclusion:Oxaliplatin and docetaxel combined with PD-1/PD-L1 inhibitors as a second-line treatment for stage IV NSCLC with negative driver genes demonstrates superior disease control,extending survival and progression-free survival,and achieving better treatment outcomes and prognosis.But attention should be paid to adverse reactions.

关 键 词：奥沙利铂 多西他赛 程序性死亡受体-1/程序性死亡配体-1抑制剂 驱动基因阴性 Ⅳ期非小细胞肺癌 

分 类 号：R734.2[医药卫生—肿瘤]