Efficacy and safety of camrelizumab plus tyrosine kinase inhibitor combined with transca theter arterial chemoembolization in middle and advanced hepatocellular carcinoma
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摘要: 目的 观察卡瑞利珠单抗加酪氨酸激酶抑制剂(TKI)联合肝动脉化疗栓塞(TACE)在中晚期肝癌中的疗效及安全性。方法 回顾性分析接受卡瑞利珠单抗加TKI联合/不联合TACE治疗的113例中晚期肝癌患者的临床资料,观察卡瑞利珠单抗加TKI联合TACE治疗(观察组)与单纯卡瑞利珠单抗加TKI治疗(对照组)在总生存期(OS)、无进展生存期(PFS)、客观缓解率(ORR)、疾病控制率(DCR)及不良反应发生率方面的差异,并分析影响患者预后的因素。结果 观察组在中位OS(18.2个月 vs 12.3个月,P<0.001)、PFS(7.4个月 vs 5.9个月,P=0.023)、ORR(48.1% vs 18.6%,P=0.001)及DCR(75.9% vs 59.3%,P=0.026)方面均优于对照组。观察组患者在发热、恶心呕吐、腹痛、肝功能损伤等不良反应发生率方面高于对照组(P<0.05)。多因素分析显示,有无门静脉癌栓及是否联合TACE治疗是影响患者预后的独立危险因素。结论 卡瑞利珠单抗加TKI联合TACE较单纯卡瑞利珠单抗加TKI可延长中晚期肝癌患者的OS和PFS,提高肿瘤局部控制率。且联合TACE治疗并未加重药物不良反应,安全性良好。Abstract: Objective To observe the efficacy and safety of camrelizumab plus tyrosine kinase inhibitor (TKI) combined with transcatheter arterial chemoembolization (TACE) in the treatment of middle and advanced liver cancer.Methods A total of 113 patients with middle and advanced liver cancer who were treated with camrelizumab plus TKI combined with/without TACE were retrospectively analyzed. The patients were divided into two groups:a carbazide plus TKI combined with TACE group (an observation group) and a camrelizumab plus TKI group (a control group). Both groups were compared for overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR) and the incidence of adverse reactions. Meanwhile, the factors influencing the prognosis of patients were analyzed.Results The observation group was superior to the control group in median OS (18.2 months vs 12.3 months, P<0.001), PFS (7.4 months vs 5.9 months, P=0.023), ORR (48.1% vs 18.6%, P=0.001) and DCR (75.9% vs 59.3%, P=0.026). The incidence of adverse reactions such as fever, nausea and vomiting, abdominal pain and liver function injury in the observation group was remarkably higher than that in the control group (P<0.05). There was no significant difference in the incidence of other adverse reactions between the two groups. Multivariate analysis showed that portal vein tumor thrombus and combined use with TACE were the independent risk factors influencing the prognosis of patients.Conclusions Compared with camrelizumab plus TKI alone, carrelizumab plus TKI combined with TACE can prolong the OS and PFS of patients with middle and advanced HCC, improve the local control rate of tumor, and do not aggravate adverse drug reactions.
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[1] Sung H,Ferlay J,Siegel RL,et al.Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2021,71(3):209-249.
[2] 张明媛,牛俊奇.东方国家原发性肝癌发病趋势及影响因素[J].临床肝胆病杂志,2018,34(7):1399-1402. [3] Xu JM,Shen J,Gu SZ,et al.Camrelizumab in combination with apatinib in patients with advanced hepatocellular carcinoma (RESCUE):a nonrandomized,open-label,phase II trial[J].Clin Cancer Res,2021,27(4):1003-1011.
[4] Qin S,Chan LS,Gu S,et al.LBA35 Camrelizumab (C) plus rivoceranib (R) vs.sorafenib (S) as first-line therapy for unresectable hepatocellular carcinoma (uHCC):a randomized,phase III trial[J].Ann Oncol,2022,33:S1401-S1402.
[5] Liu QQ,You N,Li J,et al.Camrelizumab plus sorafenib Versus sorafenib monotherapy for advanced hepatocellular carcinoma:a retrospective analysis[J/OL].Front Oncol,2021,11:694409.
[6] Wei FQ,Huang QZ,He J,et al.Lenvatinib plus camrelizumab versus lenvatinib monotherapy as post-progression treatment for advanced hepatocellular carcinoma:a short-term prognostic study[J].Cancer Manag Res,2021,13:4233-4240.
[7] Park JW,Chen MS,Colombo M,et al.Global patterns of hepatocellular carcinoma management from diagnosis to death:the BRIDGE Study[J].Liver Int,2015,35(9):2155-2166.
[8] Giunchedi P,Maestri M,Gavini E,et al.Transarterial chemoembolization of hepatocellular carcinoma.agents and drugs:an overview.part 1[J].Expert Opin Drug Deliv,2013,10(5):679-690.
[9] Ju SG,Zhou C,Yang CT,et al.Apatinib plus camrelizumab with/without chemoembolization for hepatocellular carcinoma:a real-world experience of a single center[J/OL].Front Oncol,2021,11:835889.
[10] 朱方,魏娟,赵慧慧,等.仑伐替尼和卡瑞利珠单抗联合TACE术治疗晚期或不可切除肝细胞癌临床疗效[J].东南大学学报(医学版),2022,41(4):557-561. [11] Huang JT,Zhong BY,Jiang N,et al.Transarterial chemoembolization combined with immune checkpoint inhibitors plus tyrosine kinase inhibitors versus immune checkpoint inhibitors plus tyrosine kinase inhibitors for advanced hepatocellular carcinoma[J].J Hepatocell Carcinoma,2022,9:1217-1228.
[12] Takaki H,Imai N,Contessa TT,Md P,et al.Peripheral blood regulatory T-cell and type 1 helper T-cell population decrease after hepatic artery embolization[J].J Vasc Interv Radiol,2016,27(10):1561-1568.
[13] Hickey RM,Kulik LM,Nimeiri H,et al.Immuno-oncology and its opportunities for interventional radiologists:immune checkpoint inhibition and potential synergies with interventional oncology procedures[J].J Vasc Interv Radiol,2017,28(11):1487-1494.
[14] Noman MZ,Desantis G,Janji B,et al.PD-L1 is a novel direct target of HIF-1α,and its blockade under hypoxia enhanced MDSC-mediated T cell activation[J].J Exp Med,2014,211(5):781-790.
[15] Chang Y,Jeong SW,Jang JY,et al.Recent updates of transarterial chemoembolilzation in hepatocellular carcinoma[J].Int J Mol Sci,2020,21(21):8165.
[16] Wan XY,Zhai XF,Yan ZL,et al.Retrospective analysis of transarterial chemoembolization and sorafenib in Chinese patients with unresectable and recurrent hepatocellular carcinoma[J].Oncotarget,2016,7(50):83806-83816.
[17] Peng ZW,Fan WZ,Zhu BW,et al.Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma:a phase III,randomized clinical trial (LAUNCH)[J].J Clin Oncol,2023,41(1):117-127.
[18] Kan XF,Liang B,Zhou GF,et al.Transarterial chemoembolization combined with apatinib for advanced hepatocellular carcinoma:a propensity score matching analysis[J].Front Oncol,2020,10:970.
[19] Quirk M,Kim YH,Saab S,et al.Management of hepatocellular carcinoma with portal vein thrombosis[J].World J Gastroenterol,2015,21(12):3462-3471.
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