肝动脉灌注化疗联合卡瑞利珠单抗及索拉非尼治疗中晚期肝癌的疗效与安全性分析  

Hepatic arterial infusion chemotherapy combined with carrelizumab and sorafenib for the treatment of advanced hepatocellular carcinoma:its clinical efficacy and safety

作　　者：殷梦杰 付守忠 戴锋 王斌 王晓维 丁苇 蒋逢辰 沈建东 YIN Mengjie;FU Shouzhong;DAI Feng;WANG Bin;WANG Xiaowei;DING Wei;JIANG Fengchen;SHEN Jiandong(Department of Vascular Intervention,Affiliated Nantong Third Hospital of Nantong University(Nantong Municipal Third People's Hospital),Nantong,Jiangsu Province 22600l,China)

机构地区：[1]南通大学附属南通第三医院(南通市第三人民医院)介入血管科,江苏南通226001

出　　处：《介入放射学杂志》2024年第11期1212-1217,共6页Journal of Interventional Radiology

基　　金：江苏省南通市科学技术局基金(JCZ2022019);南通市科学研究和社会民生科技计划项目(JCZ2022024)。

摘　　要：目的探讨肝动脉灌注化疗(HAIC)联合索拉非尼及卡瑞利珠单抗治疗中晚期肝细胞癌(HCC)的有效性及安全性。方法收集2019年8月到2020年8月在南通大学附属南通第三医院接受HAIC联合卡瑞利珠单抗及索拉非尼治疗的36例HCC患者的临床资料,根据改良实体瘤临床疗效评价标准(mRECIST)评估联合治疗后的客观缓解率(ORR)和疾病控制率(DCR),采用美国国家癌症研究所制定的不良事件评价标准5.0版评估治疗的安全性。结果4周期的FOLFOX-HAIC治疗后患者的ORR、DCR分别是38.9%、77.8%;随访观察30个月,患者中位无进展生存期(mPFS)306 d(95%CI:242.7~369.3),中位总生存期(mOS)为515 d(95%CI:482.5~547.5)。1例患者经治疗后成功转化行外科手术治疗。总体不良事件100%,其中3级以上不良事件9例(25%),包括严重腹痛2例(5.6%),恶心1例(2.8%),呕吐1例(2.8%),谷丙转氨酶升高3例(8.3%),谷草转氨酶升高1例(2.8%),因发生严重免疫性肺炎导致肺功能衰竭死亡1例(2.8%)。结论中晚期肝癌采用肝动脉灌注化疗联合卡瑞利珠和索拉非尼治疗具有较好的肿瘤客观缓解率和疾病控制率,且安全性可控,为中晚期肝癌的治疗提供了新的选择,但患者长期生存获益有待更大样本量研究证实。Objective To discuss the clinical efficacy and safety of hepatic arterial infusion chemotherapy(HAIC)combined with carrelizumab and sorafenib in treating advanced hepatocellular carcinoma(HCC).Methods The clinical data of 36 HCC patients,who were admitted to the Affiliated Nantong Third Hospital of Nantong University of China to receive HAIC combined with carrelizumab and sorafenib from August 2019 to August 2020,were collected.According to modified Response Evaluation Criteria in Solid Tumors(mRECIST),the objective response rate(ORR)and disease control rate(DCR)of the combination therapy were evaluated.The Common Terminology Criteria Adverse Events Version 5.0 developed by American National Cancer Institute was used to evaluate the clinical safety.Results After receiving 4 cycles of FOLFOX-HAIC,the ORR and DCR of the patients were 38.9%and 77.8%respectively.The patients were followed up for 30 months.The median progression-free survival(mPFS)was 306 days(95%CI:242.7-369.3),and the median overall survival(mOS)was 515 days(95%CI:2482.5-547.5).After HAIC treatment,one patient was successfully changed to surgical operation.The overall incidence of adverse events were 100%.There were 9 adverse events(25%)above gradeⅢ,including severe abdominal pain(n=2,5.6%),nausea(n=1,2.8%),vomiting(n=1,2.8%),elevated alanine aminotransferase(n=3,8.3%),elevated aspartate aminotransferase(n=1,2.8%),and death due to pulmonary failure caused by severe immune-induced pneumonia(n=1,2.8%).Conclusion For the treatment of advanced HCC,HAIC combined with carrelizumab and sorafenib has better ORR and DCR with controllable safety,which provides a new option for the treatment of advanced HCC.However,studies with large sample size need to be conducted before its long-term survival benefit of patients can be further validated.

关 键 词：肝细胞癌 肝动脉灌注化疗 安全性 疗效 

分 类 号：R735.7[医药卫生—肿瘤]