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肝动脉灌注化疗联合乐伐替尼和替雷利珠单抗治疗不可切除肝内胆管癌的初步临床应用

[Preliminary clinical use of hepatic arterial infusion chemotherapy combined with lenvatinib and tislelizumab in the treatment of unresectable intrahepatic cholangiocarcinoma].

作者信息

Zhou B J, Wang W S, Yin Y, Yang J, Zhu X L, Ni C F

机构信息

Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou 215006,China.

Department of Interventional Radiology, Kunshan First People's Hospital,Suzhou 215300, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2024 Aug 1;63(8):769-775. doi: 10.3760/cma.j.cn112138-20231102-00287.

Abstract

To evaluate the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) combined with lenvatinib and tislelizumab in the treatment of unresectable intrahepatic cholangiocarcinoma (ICC). The clinical data of 12 patients with unresectable ICC who received HAIC combined with lenvatinib and tislelizumab in the First Affliated Hospital of Soochow University from October 2021 to April 2023 were retrospectively analyzed. HAIC included gemcitabine plus oxaliplatin; this regimen was combined with lenvatinib and tislelizumab within 3-7 days after its initial administration. Relevant laboratory examinations were performed before each cycle of HAIC, and enhanced computed tomography/magnetic resonance imaging examinations were performed every 6-9 weeks. Tumor response to treatment was evaluated using the modified Response Evaluation Criteria in Solid Tumors. The objective response rate, disease control rate, progression-free survival, overall survival, and treatment-related adverse reactions of patients with ICC were statistically analyzed. The objective response rate to HAIC combined with lenvatinib and tislelizumab was 6/12; the disease control rate was 8/12; the median progression-free survival was 11.8 months; and the median overall survival was 14.2 months. Three patients had grade Ⅳ adverse reactions (increased alanine aminotransferase and aspartate aminotransferase thrombocytopenia), while three patients had grade Ⅲ adverse reactions (increased total bilirubin, alanine aminotransferase, and aspartate aminotransferase). The remaining patients had grade Ⅰ-Ⅱ adverse reactions. There were no serious complications related to interventional surgery. Use of HAIC (gemcitabine plus oxaliplatin) combined with lenvatinib and tislelizumab in the treatment of unresectable ICC may be safe and feasible. Preliminary clinical studies have shown that this combination can improve the survival and prognosis of patients with ICC.

摘要

评估肝动脉灌注化疗(HAIC)联合仑伐替尼和替雷利珠单抗治疗不可切除肝内胆管癌(ICC)的疗效和安全性。回顾性分析2021年10月至2023年4月在苏州大学附属第一医院接受HAIC联合仑伐替尼和替雷利珠单抗治疗的12例不可切除ICC患者的临床资料。HAIC方案为吉西他滨联合奥沙利铂;该方案在首次给药后3至7天内与仑伐替尼和替雷利珠单抗联合使用。在每个HAIC周期前进行相关实验室检查,每6至9周进行增强计算机断层扫描/磁共振成像检查。采用改良实体瘤疗效评价标准评估肿瘤对治疗的反应。对ICC患者的客观缓解率、疾病控制率、无进展生存期、总生存期及治疗相关不良反应进行统计学分析。HAIC联合仑伐替尼和替雷利珠单抗的客观缓解率为6/12;疾病控制率为8/12;中位无进展生存期为11.8个月;中位总生存期为14.2个月。3例患者出现Ⅳ级不良反应(谷丙转氨酶、谷草转氨酶升高及血小板减少),3例患者出现Ⅲ级不良反应(总胆红素、谷丙转氨酶及谷草转氨酶升高)。其余患者出现Ⅰ-Ⅱ级不良反应。未发生与介入手术相关的严重并发症。使用HAIC(吉西他滨联合奥沙利铂)联合仑伐替尼和替雷利珠单抗治疗不可切除ICC可能安全可行。初步临床研究表明,这种联合治疗可改善ICC患者的生存及预后。

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