纳武利尤单抗联合培美曲塞治疗晚期NSCLC对患者疗效及预后的影响

Effects of nivolumab combined with pemetrexed on efficacy and prognosis in the treatment of advanced NSCLC

目的:分析程序性死亡受体-1(programmed death receptor-1,PD-1)/程序性死亡受体配体-1(programmed death receptor ligand-1,PD-L1)抑制剂纳武利尤单抗联合培美曲塞治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效及对预后的影响。方法:招募2018年1月―2021年1月我院收治的98例晚期NSCLC患者,按随机数字表法分为观察组(49例,培美曲塞+纳武利尤单抗治疗)与对照组(49例,培美曲塞治疗),两组患者均连续用药到出现不耐受或疾病进展。记录两组治疗后(2个化疗周期)临床疗效、治疗期间不良反应,比较治疗前、后两组免疫功能(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、血清相关因子[血清前梯度蛋白2(recombinant anterior gradient protein 2,AGR2)、金属基质蛋白酶-9(matrix metalloprotein-9,MMP-9)]、生活质量[Karnofsky评分(KPS评分)]水平。结果:2个化疗周期内两组均无死亡病例,观察组临床客观缓解率(objetive response rate,ORR)(57.14%)显著高于对照组(36.73%),治疗前后CD3^(+)、CD8^(+)、AGR2、MMP-9、KPS评分差值绝对值显著大于对照组,CD4^(+)、CD4^(+)/CD8^(+)差值绝对值显著小于对照组。两组不良反应无显著差异,出现症状患者经下调药物剂量25%~50%及对症处理后耐受良好,可控。结论:纳武利尤单抗联合培美曲塞治疗晚期NSCLC可提高短期缓解效果,增强患者机体免疫功能,提高生活质量,未明显增加不良反应发生率。

Objective To analyze the efficacy of programmed death receptor-1(PD-1)/programmed death receptor ligand-1(PD-L1)inhibitor nivolumab combined with pemetrexed in the treatment of advanced non-small cell lung cancer(NSCLC)and its effects on prognosis.Method A total of 98 patients with advanced NSCLC treated in the hospital from January 2018 to January 2021 were recruited and divided into observation group(49 cases,pemetrexed+nivolumab)and control group(49 cases,pemetrexed)by the random number table method.Both groups of patients were continuously treated until intolerance or disease progression occurred.The clinical efficacy after treatment(2 cycles of chemotherapy)and adverse reactions during treatment in the two groups were recorded.The immune function(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),serum related factors[serum recombinant anterior gradient protein 2(AGR2),matrix metalloproteinase-9(MMP-9)]and quality of life[Karnofsky Performance Status(KPS score)]were compared between the two groups before and after treatment.Results There were no deaths in both groups within 2 cycles of chemotherapy,and the clinical objective response rate(ORR)of 57.14%in observation group was significantly higher than 36.73%in control group,and the absolute difference values of CD3^(+),CD8^(+),AGR2,MMP-9 and KPS score before and after treatment were significantly higher than those in control group while the absolute difference values of CD4^(+)and CD4^(+)/CD8^(+)were significantly lower than those in control group.There were no significant differences in the adverse reactions between the two groups,and the patients with symptoms were well tolerated and controlled by 25%~50%downregulated dose and symptomatic treatment.Conclusion Nivolumab combined with pemetrexed in the treatment of advanced NSCLC can improve the short-term relief effect,strengthen the body's immune function and enhance the quality of life,and it does not significantly increase the incidence rates of adverse reactions.