经导管动脉灌注PD-1单抗治疗恶性肿瘤所致免疫相关不良反应

Analysis of immune-related adverse events caused by transcatheter arterial infusion of PD-1 monoclonal antibody in patients with malignant tumors

目的探讨恶性肿瘤患者经导管动脉灌注程序性死亡蛋白-1(programmed death-1,PD-1单抗治疗的免疫相关不良反应(immune-related adverse events,irAE)。方法收集接受经导管动脉灌注PD-1单抗治疗的79例患者的临床资料,包括性别、年龄、灌注次数、PD-1单抗经导管动脉灌注治疗免疫相关不良事件等信息,采用SPSS26.0统计软件分析不同灌注次数患者irAE的发生率、首次灌注时不同等级irAE的发生率,采用logistic回归分析免疫irAE的影响因素。结果经导管动脉灌注PD-1单抗治疗晚期恶性肿瘤患者中,任何级别和2级及以上irAE发生率分别为82.27%和27.8%,其中发生3级不良反应患者仅2例;疲劳的不良反应发生率居首位,与是否首次灌注、是否联合化疗及是否单部位灌注有关;irAE发生率前5位分别为:疲劳、恶心、关节痛、瘙痒及皮疹。不良反应可自行缓解,无死亡病例及严重irAE的发生。结论经导管动脉灌注PD-1单抗治疗晚期恶性肿瘤不良反应发生率较高,但以1~2级为主,耐受性好,可重复多疗程治疗,不良反应可自行缓解,且未引起治疗中断,是晚期恶性肿瘤患者可选择的新的治疗方式之一。

Objective To discuss the immune-related adverse events(irAEs)in patients with malignancy who underwent transcatheter arterial infusion of programmed cell death protein-1(PD-1)monoclonal antibody.Methods The clinical data,including gender,age,number of infusion times,irAEs,etc,of 79 patients who received transcatheter arterial infusion of PD-1 monoclonal antibody therapy were collected.By using SPSS 26.0 statistical software,the incidence of irAEs in patients having received different number of infusion times and the incidences of different grade irAEs after the initial infusion were analyzed.Logistic regression analysis was used to evaluate the risk factors for irAEs.Results The incidence of any grade irAEs and the incidence of grade II or above II irAEs were 82.27%and 27.8%respectively,among them gradeⅢirAEs occurred only in 2 patients.The incidence of fatigue ranked first in all irAEs,which might be related to the initial infusion,combined chemotherapy,or single site perfusion.The top five of irAEs incidence were fatigue,nausea,joint pain,itching and rash.Through medical-nursing cooperation and integrated management,all kinds of irAEs could be alleviated,and no death or severe irAEs occurred.Conclusion In treating patients with advanced malignancy,transcatheter arterial infusion of PD-1 monoclonal antibody carries higher incidence of irAEs.The adverse reactions are mainly of gradeⅠ-Ⅱ,and usually patients can well tolerate these adverse reactions,thus,transcatheter arterial infusion of PD-1 monoclonal antibody can be repeated many times.The irAEs can be relieved spontaneously or through medical-nursing management,so the therapeutic scheme will not be interrupted.Therefore,transcatheter arterial infusion of PD-1 monoclonal antibody is a new alternative treatment for patients with advanced malignancy.