FOLFOX-HAIC联合免疫靶向治疗初始不可切除肝细胞癌患者的有效性和安全性分析  

Analysis of the efficacy and safety of FOLFOX-HAIC combined with targeted immunotherapy for initially unresectable hepatocellular carcinoma

作　　者：陆彦岑 杨宇尘 马迪[1] 王俊青[1] 郝风节 陈旭晓 陈拥军[1] Lu Yancen;Yang Yuchen;Ma Di;Wang Junqing;Hao Fengjie;Chen Xuxiao;Chen Yongjun(Department of Hepatobiliary Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肝胆外科,上海200025

出　　处：《中华肝胆外科杂志》2024年第11期813-818,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：北京医学奖励基金会(YXJL-2020-0191-0024)。

摘　　要：目的分析氟尿嘧啶、亚叶酸钙和奥沙利铂(FOLFOX)-肝动脉灌注化疗(HAIC)联合免疫靶向治疗初始不可切除肝细胞癌的有效性和安全性。方法回顾分析2022年6月至2023年6月于上海交通大学医学院附属瑞金医院就诊的初始不可手术切除的肝细胞癌患者资料。共入组51例患者,其中男性47例,女性4例,年龄(56.1±10.7)岁。51例患者均接受FOLFOX-HAIC联合免疫靶向治疗。在每次HAIC联合免疫靶向治疗后根据改良实体瘤临床疗效评价标准(mRECIST)评估疗效,计算客观缓解率和疾病控制率。记录转化手术率。随访患者疾病进展和生存情况,生存分析采用Kaplan-Meier法。记录治疗期间的不良事件。结果根据mRECIST评估51例患者完全缓解、部分缓解、疾病稳定和疾病进展分别为4例(7.8%)、27例(52.9%)、14例(27.4%)和6例(11.8%),疾病缓解率为60.8%(31/51),疾病控制率为88.2%(45/51)。经HAIC联合免疫靶向治疗后,行手术切除的患者有13例,手术转化率为25.5%(13/51)。51例患者中位无进展生存期为14.2个月,中位总生存期尚未达到。51例患者6个月和12个月的无进展生存率为90.2%和64.7%,6个月和12个月的累积生存率为100%和86.3%。治疗期间,51例患者均出现不同程度的不良反应,38例(74.5%)为1~2级不良事件,对症治疗后可缓解控制,无严重不良事件。结论FOLFOX-HAIC联合免疫靶向治疗为初始不可切除的肝细胞癌患者提供了一种有效且安全的治疗选择,为不可切除的肝细胞癌患者提供手术切除机会。Objective To analyze the efficacy and safety of FOLFOX-hepatic arterial infusion chemotherapy(HAIC)combined with targeted immunotherapy for initial unresectable hepatocellular carcinoma.Methods A retrospective analysis was conducted on the data of initial unresectable hepatocellular carcinoma patients who visited Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from June 2022 to June 2023.A total of 51 patients were enrolled,including 47 males and 4 females,with the age of(56.1±10.7)years.All 51 patients received HAIC combined with immune targeted therapy.After each HAIC combined with immune targeted therapy,the efficacy was evaluated according to the modified response evaluation cirteria in solid tumor(mRECIST).Objective response rate and disease control rate were calculuted.The conversion surgery rate and adverse events during treatment were recorded.Follow up patients'disease progression and survival status,and meanwhile analyze prognosis.Results According to mRECIST assessment,the number of patients with complete remission,partial remission,disease stability,and disease progression were 4(7.8%),27(52.9%),14(27.4%),and 6(11.8%),respectively.The disease remission rate was 60.8%(31/51),and the disease control rate was 88.2%(45/51).After HAIC combined with immune targeted therapy,13 patients underwent liver cancer resection,with a surgical conversion rate of 25.5%(13/51).The median progression free survival of 51 patients was 14.2 months,and the median overall survival has not yet been reached.The progression free survival rates of 51 patients at 6 and 12 months were 90.2%and 64.7%,respectively,and the cumulative survival rates at 6 and 12 months were 100%and 86.3%,respectively.During the treatment period,all patients experienced various degrees of adverse reactions,38(75.5%)patients were grade 1-2 adverse accidents,which could be relieved and controlled after corresponding treatment.Conclusion FOLFOX-HAIC combined with targeted immunotherapy provides an effective and safe treatment

关 键 词：癌 肝细胞 肝动脉灌注化疗 靶向治疗 免疫治疗 转化治疗 

分 类 号：R735.7[医药卫生—肿瘤]