TACE联合卡瑞利珠单抗及甲磺酸阿帕替尼治疗晚期肝细胞癌16例

TACE combined with camrelizumab and apatinib for advanced hepatocellular carcinoma: preliminary results in 16 patients

目的评估TACE联合卡瑞利珠单抗及甲磺酸阿帕替尼治疗晚期肝细胞癌(HCC)的安全性及疗效。方法回顾性分析我科2019年1月至2020年12月接受TACE联合卡瑞利珠单抗及阿帕替尼治疗的HCC患者临床资料。依据NCI-CTCAE(National Cancer Institute’s Common Terminology Criteria for Adverse Events)标准评估患者联合治疗后不良事件发生率,依据mRECIST标准分析患者肿瘤完全缓解(CR)率、部分缓解(PR)率、稳定(SD)、肿瘤进展(PD)、疾病控制率(DCR)、无进展生存期(PFS)及总生存期(OS)。采用SPSS软件对患者随访数据进行分析。结果收集联合治疗资料完善且符合本研究方案的患者16例。中位随访时间11个月(3~26个月)。TACE术后16(100%)例患者均出现栓塞后综合征,14(87.5%,95%CI,69.3%~100%)例患者出现靶向药及PD-1相关并发症,其中6例(37.5%)患者出现3级并发症,包括2例(12.5%,95%CI,0~30.7%)手足综合征、3例(18.75%,95%CI,0-40.2%)腹泻及1例(6.2%,95%CI,0~19.6%)免疫性肺炎。16例患者中2例(12.5%,95%CI,0~30.7%)CR,10例(62.5%,95%CI,35.9%~89.1%)PR,2例(12.5%,95%CI,0~30.7%)SD;14例(87.5%,95%CI,69.3%~100%)DCR。中位PFS长达9个月(95%CI, 5.58~13.29个月),中位OS长达12个月(95%CI,9.04~16.09个月)。结论 TACE联合卡瑞利珠单抗及甲磺酸阿帕替尼治疗晚期肝细胞癌严重不良事件发生率低、肿瘤控制率高,患者生存明显获益。

Objective To evaluate the effectiveness and safety of transcatheter arterial chemoembo-lization(TACE) combined with camrelizumab and apatinib in the treatment of advanced hepatocellular carcinoma(HCC). Methods The clinical data of advanced HCC patients, who received TACE combined with camrelizumab and apatinib between January 2019 and December 2020 at authors’ Department, were retrospectively analyzed. According to National Cancer Institute’s Common Terminology Criteria for Adverse Events(NCI-CTCAE) standards, the incidences of postoperative adverse events were assessed. Based on modified response evaluation criteria in solid tumor(mRECIST), the complete remission(CR) rate, partial remission(PR) rate, stable disease(SD) rate, progression disease(PD) rate, disease control(DC) rate, progression-free survival(PFS) and overall survival(OS) were evaluated. SPSS software was used to analyze the patients’ follow-up data. Results A total of 16 HCC patients, who had complete information and were consistent with this research program, were enrolled in this study. The median follow-up time was 11 months(3-26 months). After TACE, 16 patients developed post-embolism syndrome(100%), and 14 patients developed targeted drugrelated and PD-1-related complications(87.5%, 95% CI =69.3%-100%), of whom 6(37.5%) developed severe grade 3 complications, including hand-foot syndrome(n=2, 12.5%, 95%CI=0%-30.7%), diarrhea(n=3, 18.75%, 95%CI=0%-40.2%) and immune pneumonia(n=1, 6.25%, 95%CI=0%-19.6%). Among the16 patients, CR was obtained in 2(12.5%, 95%CI=0%-30.7%), PR in 10(62.5%, 95%CI=35.9%-89.1%), SD in 2(12.5%, 95%CI=0%-30.7%), and DC in 14(87.5%, 95%CI=69.3%-100%). The median PFS was up to 9 months(95%CI=5.58-13.29 months) and the median OS was up to 12 months(95%CI=9.04-16.09 months).Conclusion For the treatment of advanced HCC, TACE combined with camrelizumwithd apatinib has low incidence of severe complications and high tumor control rate, providing patients with great benefits.(J Intervent Radiol, 2021, 30:774-779)