卡瑞利珠单抗对晚期非小细胞肺癌脑转移患者的疗效及驱动基因突变关联分析  

Efficacy of camrelizumab in treatment of advanced non small cell lung cancer in patients with brain metastases and its correlation with drive gene mutation

作　　者：李辉 蒋婷[2] 周宗正 Li Hui;Jiang Ting;Zhou Zong-zheng(Department of Pharmacy,Affiliated Hospital of Huaibei Vocational and Technical College,Huaibei 235100,China;Department of Pharmacy,the First Affiliated Hospital,Chengdu Medical College,Chengdu 610599,China;Department of Oncology,Affiliated Hospital of Huaibei Vocational and Technical College,Huaibei 235100,China)

机构地区：[1]淮北市职业技术学院附属医院药学部,淮北235100 [2]成都医学院第一附属医院药学部,成都610599 [3]淮北市职业技术学院附属医院肿瘤内科,淮北235100

出　　处：《中国药物应用与监测》2024年第3期216-220,共5页Chinese Journal of Drug Application and Monitoring

摘　　要：目的探索卡瑞利珠单抗对Ⅲb期-Ⅳ期非小细胞肺癌(NSCLC)患者脑转移的疗效,以及驱动基因突变对疗效的影响。方法回顾性分析淮北市职业技术学院附属医院2020年1月至2022年1月收治合并脑转移的NSCLC患者,按照是否联合使用卡瑞利珠单抗分为对照组(51例)和观察组(47例)。对照组和观察组患者进行同步放化疗和立体定向放射外科治疗;此外,观察组患者额外接受注射用卡瑞利珠单抗治疗。观察组患者根据其脑转移情况分为单发脑转移和多发脑转移两个亚组,根据驱动基因突变情况分为驱动基因阳性和阴性两个亚组。比较观察组和对照组以及观察组亚组间的客观缓解率和预后的差异。结果治疗结束后,两组患者近期疗效比较显示,观察组客观缓解率高于对照组[36.17%(17/47)vs 23.53%(12/51),χ^(2)=4.305,P<0.05]。经1年随访,观察组无进展生存期[(9.45±1.16)个月vs(6.34±1.05)个月,χ^(2)=6.385,P<0.05]和总生存期[(13.69±2.15)个月vs(10.41±1.19)个月,χ^(2)=7.743,P<0.05],均差异有统计学意义。观察组有18例为单发脑转移患者,29例为多发脑转移患者。单发脑转移患者客观缓解率(χ^(2)=4.748,P<0.05)、无进展生存期(χ^(2)=7.458,P<0.05)和总生存期(χ^(2)=9.401,P<0.05)均高于多发脑转移患者。脑转移患者中,有6例为驱动基因突变者,41例无驱动基因突变者。有驱动基因突变患者总生存期时间[(15.46±3.16)个月vs(7.86±1.85)个月]和无进展生存期[(12.03±1.96)个月vs(5.41±1.17)个月]均高于无驱动基因突变者,差异有统计学意义(χ^(2)=11.254,6.988,均P<0.05)。结论联用卡瑞利珠单抗治疗脑转移临床疗效更佳,单发脑转移患者客观缓解率高于多发脑转移,合并驱动基因突变者对卡瑞利珠单抗敏感性更高。Objective To investigate the clinical efficacy of camrelizumab in the treatment of stageⅢb andⅣadvanced non small cell lung cancer(NSCLC)with brain metastases and explore the impact of driver gene mutation on therapeutic efficacy.Methods The clinical data of 98 NSCLC patients with brain metastasis admitted to the Affiliated Hospital of Huaibei Vocational and Technical College from January 2020 to January 2022 were retrospectively analyzed.They were divided into the control group(n=51)and the observation group(n=47)based on whether or not they were treated in combination with camrelizumab.Patients in both groups were treated with concurrent chemoradiotherapy and stereotactic radiosurgery.In addition,the patients in the observation group received additional treatment with injection of camrelizumab.Patients in the observation group were divided into two subgroups based on their brain metastases:single brain metastases and multiple brain metastases.Meanwhile,they were also divided into two subgroups based on their driver gene mutations:positive and negative.Objective remission rate and prognosis were compared between the observation group and the control group,as well as the subgroups of the observation group.Results After treatment,the results of short-term efficacy determination showed that the objective response rate in the observation group was significantly higher than that in the control(36.17%(17/47)vs 23.53%(12/51),χ^(2)=4.305,P<0.05).After one-year of follow-up,the progression-free survival time((9.45±1.16)months vs(6.34±1.05)months,χ^(2)=6.385,P<0.05)and overall survival time((13.69±2.15)months vs(10.41±1.19)months,χ^(2)=7.743,P<0.05)in the observation group were both longer than those of the control group.There were 18 patients with single brain metastasis and 29 patients with multiple brain metastasis in the observation group. The objective response rate ( χ^(2)=4.748, P<0.05), progression-free survival time ( χ^(2)=7.458, P<0.05), and overall survival time ( χ^(2)=9.401, P<0.05) in the pati

关 键 词：非小细胞肺癌 卡瑞利珠单抗 肿瘤分期 脑转移 

分 类 号：R979.1[医药卫生—药品]