经动脉化疗栓塞术序贯肝动脉灌注化疗联合TKI和PD-1抑制剂作为晚期肝细胞癌一线治疗的疗效与安全性
[Efficacy and safety of transcatheter arterial chemoembolization followed by hepatic arterial infusion chemotherapy combined with TKI and PD-1 inhibitors as first-line treatment for advanced hepatocellular carcinoma].
作者信息
Zhang L, Liu X, Hu X, Wang J, Yu X, Li G, You H, Zhang Q, Zhang H
机构信息
Department of Oncology, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510405, China.
Department of Oncology, Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Foshan 528200, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2024 Sep 20;44(9):1831-1838. doi: 10.12122/j.issn.1673-4254.2024.09.24.
OBJECTIVE
To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) followed by hepatic arterial infusion chemotherapy (HAIC) combined with TKI drugs and PD-1 inhibitors as the first-line treatment for advanced hepatocellular carcinoma (HCC).
METHODS
We retrospectively analyzed the data of 70 patients with advanced HCC treated in the Department of Oncology of Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine between July, 2020 and June, 2023. 23 of the patients received TACE combined with HAIC and TKI (TACE+HAIC+ TKI group) and 47 received TACE combined with HAIC, PD-1 inhibitors and TKI (TACE+HAIC+PD-1+TKI group). The clinical characteristics, laboratory test results, efficacy, outcomes and adverse events of the patients were compared between the two groups.
RESULTS
The TACE+HAIC+TKI and TACE+HAIC+PD-1+TKI groups had significantly different objective remission rates (ORR; 60.87% 36.17%, =0.031), comparable disease control rates (95.65% 93.62%, =0.068), and different median progression-free survival (PFS) time (10.2 11.8 months, =0.003) and median overall survival (OS) time (15.7 19.5 months, =0.035). After propensity score matching (PSM), the median PFS and OS time of the two groups was 10.1 14.5 months (= 0.024) and 14.2 21.2 months (=0.221), respectively. The 1-year PFS rates of the 2 groups were 24.0% 52.2%, and the 1-, 2-and 3-year OS rates were 72.3% 93.1%, 23.9% 63.8%, and 23.9% 36.5%, respectively. The incidence of proteinuria was significantly higher in TACE+HAIC+PD-1+TKI group than in TACE+HAIC+TKI group (21.28% 0, =0.025), but the incidences of grade 3-4 treatment-related adverse events were all similar between the two groups.
CONCLUSION
The first-line treatment with TACE+HAIC+PD-1+TKI is safe and effective for advanced HCC and can significantly prolong the survival of the patients.
目的
评估经动脉化疗栓塞术（TACE）序贯肝动脉灌注化疗（HAIC）联合酪氨酸激酶抑制剂（TKI）类药物及程序性死亡受体1（PD-1）抑制剂作为晚期肝细胞癌（HCC）一线治疗方案的疗效及安全性。
方法
回顾性分析2020年7月至2023年6月期间在广东省中西医结合医院肿瘤科接受治疗的70例晚期HCC患者的数据。其中23例患者接受TACE联合HAIC及TKI治疗（TACE+HAIC+TKI组），47例患者接受TACE联合HAIC、PD-1抑制剂及TKI治疗（TACE+HAIC+PD-1+TKI组）。比较两组患者的临床特征、实验室检查结果、疗效、预后及不良事件。
结果
TACE+HAIC+TKI组与TACE+HAIC+PD-1+TKI组的客观缓解率（ORR）差异有统计学意义（60.87%对36.17%，P=0.031），疾病控制率相近（95.65%对93.62%，P=0.068），无进展生存期（PFS）中位数及总生存期（OS）中位数不同（10.2个月对11.8个月，P=0.003；15.7个月对19.5个月，P=0.035）。倾向评分匹配（PSM）后，两组的PFS中位数及OS中位数分别为10.1个月对14.5个月（P=0.024）和14.2个月对21.2个月（P=0.221）。两组的1年PFS率分别为24.0%对52.2%，1年、2年及3年OS率分别为72.3%对93.1%、23.9%对63.8%、23.9%对36.5%。TACE+HAIC+PD-1+TKI组蛋白尿的发生率显著高于TACE+HAIC+TKI组（21.28%对0，P=0.025），但两组3/4级治疗相关不良事件的发生率相似。
结论
TACE+HAIC+PD-1+TKI一线治疗晚期HCC安全有效，可显著延长患者生存期。
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