乐伐替尼治疗后雷莫西尤单抗用于不可切除肝细胞癌进展后治疗的疗效
Therapeutic efficacy of ramucirumab after lenvatinib for post-progression treatment of unresectable hepatocellular carcinoma.
作者信息
Hiraoka Atsushi, Kumada Takashi, Tada Toshifumi, Ogawa Chikara, Tani Joji, Fukunishi Shinya, Atsukawa Masanori, Hirooka Masashi, Tsuji Kunihiko, Ishikawa Toru, Takaguchi Koichi, Kariyama Kazuya, Itobayashi Ei, Tajiri Kazuto, Shimada Noritomo, Shibata Hiroshi, Ochi Hironori, Kawata Kazuhito, Toyoda Hidenori, Ohama Hideko, Nouso Kazuhiro, Tsutsui Akemi, Nagano Takuya, Itokawa Norio, Hayama Korenobu, Arai Taeang, Imai Michitaka, Koizumi Yohei, Nakamura Shinichiro, Michitaka Kojiro, Hiasa Yoichi, Kudo Masatoshi
机构信息
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
出版信息
Gastroenterol Rep (Oxf). 2020 Oct 10;9(2):133-138. doi: 10.1093/gastro/goaa042. eCollection 2021 Apr.
BACKGROUND
Lenvatinib is used for unresectable hepatocellular carcinoma (u-HCC) as first-line, as well as second- and third-line therapy in Japan. We evaluated the therapeutic efficacy of newly developed ramucirumab when given after lenvatinib for post-progression treatment.
METHODS
Of 385 patients with u-HCC and treated with lenvatinib at 16 different institutions in Japan between May 2018 and January 2020, 28 who received ramucirumab as the next treatment were enrolled and therapeutic responses were evaluated in a retrospective manner.
RESULTS
The median age of the 28 patients given ramucirumab was 70 years and the median albumin-bilirubin score was -2.19. Of the 28 patients, 23 were male, 21 were classified as Child-Pugh A and 7 as Child-Pugh B, and 25 were Barcelona Clinic Liver Cancer Stage C. Ramucirumab was given as second-line therapy in 14, third-line in 9, and fourth-line in 5. Therapeutic response was obtained in only 26 patients; the objective response rate was 3.8% (1/26) and the disease-control rate was 42.3% (11/26), with a median period to progression of 2.0 months. The reasons for discontinuation of ramucirumab were progression of disease in 16 and Grade 3 adverse events (gastrointestinal bleeding, ascites) in 2.
CONCLUSIONS
The anticipated therapeutic efficacy of ramucirumab for post-progression treatment following lenvatinib was not seen in our early experience.
背景
在日本，乐伐替尼用于不可切除肝细胞癌（u-HCC）的一线治疗，以及二线和三线治疗。我们评估了新开发的雷莫西尤单抗在乐伐替尼治疗进展后给予时的治疗效果。
方法
2018年5月至2020年1月期间，在日本16个不同机构接受乐伐替尼治疗的385例u-HCC患者中，28例接受雷莫西尤单抗作为后续治疗的患者被纳入研究，并以回顾性方式评估治疗反应。
结果
接受雷莫西尤单抗治疗的28例患者的中位年龄为70岁，中位白蛋白-胆红素评分为-2.19。28例患者中，23例为男性，21例分类为Child-Pugh A级，7例为Child-Pugh B级，25例为巴塞罗那临床肝癌C期。雷莫西尤单抗作为二线治疗的有14例，三线治疗的有9例，四线治疗的有5例。仅26例患者获得了治疗反应；客观缓解率为3.8%（1/26），疾病控制率为42.3%（11/26），中位进展期为2.0个月。停用雷莫西尤单抗的原因是16例疾病进展，2例出现3级不良事件（胃肠道出血、腹水）。
结论
在我们的早期经验中，未观察到雷莫西尤单抗在乐伐替尼治疗进展后进行后续治疗时预期的治疗效果。
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