阿替利珠单抗联合贝伐珠单抗治疗TACE抵抗中晚期肝细胞癌的疗效及安全性分析  

Efficacy and safety analysis of atezolizumab combined with bevacizumab in the treatment of TACE-resistant advanced hepatocellular carcinoma

作　　者：郭栋 张锋利[2] 郑伟 GUO Dong;ZHANG Fengli;ZHENG Wei(Department of the Second General Surgery,Shaanxi Provincial Nuclear Industry 215 Hospital,Xianyang,712000,Shaanxi,China;Department of Gastroenterology,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang,712099,Shaanxi,China)

机构地区：[1]陕西省核工业二一五医院普外二科,陕西咸阳712000 [2]陕西中医药大学第二附属医院胃病科,陕西咸阳712099

出　　处：《肿瘤药学》2024年第6期731-737,共7页Anti-Tumor Pharmacy

基　　金：陕西省中医药管理局中医药科研课题(JCMS014)。

摘　　要：目的探讨阿替利珠单抗联合贝伐珠单抗治疗经肝动脉化疗栓塞术(TACE)抵抗的中晚期肝细胞癌(HCC)的疗效及安全性。方法选取2020年1月至2022年12月我院收治的84例TACE抵抗的中晚期HCC患者,根据治疗方法不同分为对照组和试验组,每组42例。在按需行TACE的基础上,对照组采用索拉非尼治疗,试验组采用阿替利珠单抗联合贝伐珠单抗治疗。比较两组患者的疗效、肿瘤标志物和血管生成因子水平、肿瘤无进展生存期(PFS)及不良反应。结果试验组治疗总有效率(73.81%)明显高于对照组(47.62%)(P<0.05);治疗后,两组患者血清甲胎蛋白(AFP)、血小板衍生生长因子(PDGF)、碱性成纤维细胞生长因子(bFGF)、血管内皮生长因子(VEGF)水平均低于治疗前,且试验组显著低于对照组(P<0.05);随访9~32个月,试验组患者中位PFS明显长于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05),但试验组免疫性皮炎发生率明显高于对照组(P<0.05)。结论阿替利珠单抗与贝伐珠单抗联合疗法对TACE抵抗的中晚期HCC患者疗效显著,能有效降低肿瘤标志物与血管生成因子水平,延长PFS,整体安全性较好。Objective To investigate the efficacy and safety of atezolizumab combined with bevacizumab in the treat-ment of transcatheter arterial chemoembolization(TACE)-resistant advanced hepatocellular carcinoma(HCC).Methods A total of 84 patients with TACE-resistant advanced HCC admitted to our hospital between January 2020 and December 2022 were selected,and divided into the control group(n=42)and the test group(n=42)according to different treatment methods.On the basis of on-demand TACE,the control group was treated with sorafenib,while the test group was treated with atezolizumab and bevacizumab.A comparison was made between the two groups,focusing on the curative effects,lev-els of tumor markers,angiogenic factors,progression-free survival(PFS),and any adverse reactions experienced.Results The test group demonstrated a significantly higher effective treatment rate than the control group(73.81%vs.47.62%)(P<0.05).After treatment,the serum levels of alpha fetoprotein(AFP),platelet-derived growth factor(PDGF),basic fibroblast growth fac-tor(bFGF)and vascular endothelial growth factor(VEGF)in the two groups were lower than those before treatment,and those in the test group were lower than those in the control group(P<0.05).The duration of follow-up in this study ranged from 9 to 32 months,with no patients lost tracking.The median PFS of the test group was 10 months,which was longer than that of the control group(5 months),and the difference was statistically significant(χ^(2)=5.72,P=0.017).The difference between the two groups in the incidence rate of adverse reactions did not reach statistical significance(P>0.05),but the test group exhib-ited a significantly higher incidence rate of immune dermatitis than the control group(P<0.05).Conclusion The combina-tion therapy of atezolizumab and bevacizumab has a significant effect on patients with TACE-resistant advanced HCC.It can effectively improve the levels of tumor markers and angiogenic factors,prolong the progression-free survival of pa-tients,with relatively good safet

关 键 词：肝细胞癌 经肝动脉化疗栓塞术 索拉非尼 阿替利珠单抗 贝伐珠单抗 

分 类 号：R735.7[医药卫生—肿瘤] R979.5[医药卫生—临床医学]