DC-CIK细胞联合化疗治疗广泛期小细胞肺癌的临床疗效

Clinical efficacy of DC-CIK cell combined with chemotherapy in treatment of extensive-stage small cell lung cancer

目的:评价DC-CIK细胞联合化疗对广泛期小细胞肺癌(small cell lung cancer,SCLC)的有效性及安全性。方法:收集2012年2月至2015年1月就诊于上海东方肝胆外科医院的15例广泛期SCLC患者,采用EP方案(依托泊甙+顺铂)化疗结束后3~5 d进行DC-CIK细胞治疗,每21 d为一周期,观察联合治疗前后患者外周血中T细胞亚群的变化、临床疗效、生活质量和不良反应等。结果:15例患者均可评价疗效,获CR 3例、PR 8例、SD 3例、PD 1例、RR为73.3%,DCR为93.3%,PFS为6.8个月,OS为14.9个月,其中2例获CR的患者OS分别为29.1个月、37.2个月,2年生存率达13.3%;联合治疗后较治疗前CD4^+CD25^+CD127^-调节性T细胞、CD4^+T细胞减少[(5.42±0.70)%vs(6.16±0.77)%,P<0.05;(28.74±1.92)%vs(33.06±2.69)%,P<0.05],CD3^+CD56^+细胞因子诱导的杀伤细胞、CD8^+T细胞增加[(5.58±0.94)%vs(4.94±0.77)%,P<0.05;(43.26±3.87)%vs(39.92±2.78)%,P<0.01],CD4^+/CD8^+T细胞比值明显下降[(0.67±0.09)%vs(0.83±0.10)%,P<0.01];治疗后患者KPS评分提高20分2例、10分9例,有效率为73.3%,不良反应主要表现为轻中度骨髓抑制、胃肠道反应,给予对症处理后可恢复正常。结论:DC-CIK细胞联合化疗可提高广泛期SCLC患者的临床缓解率,延长生存期,明显改善生活质量,增强免疫功能,安全有效。

Objective：To evaluate the safety and efficacy of dentritic cell（DC）-cytokine induced killer cells（CIKs）immune therapy combined with chemotherapy in treatment of extensive-stage small cell lung cancer（SCLC）.Methods：Fifteen extensive-stage SCLC patients,who were admitted to Shanghai Eastern Hepatobiliary Surgery Hospital from June2012 to January 2015,received DC-CIKs immune therapy after 3-5 days of EP chemotherapy（VP16 ＋ DDP）,three weeks for one cycle.The changes in T cell subsets in peripheral blood of patients before and after the combined treatment,clinical efficacy,life quality,and adverse events were observed.Results：All the 15 patients responded to the combined treatment,among them,3 achieved CR,8 cases of PR,3 cases of SD and 1 cases of PD.The response rate（RR） and disease control rate（DCR） were 73.3%and 93.3%,respectively.The median progression free survival（PFS） and overall survival（OS） was 6.8 months and 14.9 months,respectively.The OS of the two patients obtained CR was 29.1 months and37.2 months,respectively.Compared to pre-treatment,regulatory T cell（Treg） and CD4~＋ T cells decreased（[5.42 ±0.70]%vs[6.16 ±0.77]%,P〈0. 05;[28.74 ± 1.92]%vs[33.06 ± 2.69]%,P〈0. 05）,while CIKs and CD8~＋ T cells increased（[5.58 ±0.94]%vs[4.94 ±0.77]%,P〈0. 05;[43.26 ±3.87]%vs[39.92 ±2.78]%,P〈0. 01） after the combined treatment,and the CD4~＋ /CD8~＋ T cells ratio declined significantly（[0.67 ±0.09]%vs[0.83 ±0.10]%,P〈0.01）.2 patients improved with 20 scores and 9 improved with 10 scores in KPS evaluation with a effective rate of 73.3%.The side effects mainly were mild myelosuppression and gastrointestinal reaction patients could recover after symptomatic treatment.Conclusion：DC-CIK combined with chemotherapy can improve the clinical remission rate of extensive-stage SCLC,prolong the survival time,and improve quality of life and immune function,it is safe and effective that deserves further study.