不同剂量阿帕替尼联合卡瑞利珠单抗对肝癌患者晚期治疗的疗效及安全性观察

The efficacy and safety of different doses of apatinib combined with carelizumab in the treatment of advanced liver cancer

目的探究不同剂量阿帕替尼联合卡瑞利珠单抗对肝癌患者晚期治疗的疗效及安全性。方法将2017年10月至2020年10月宣城市中心医院收治的68例晚期肝细胞癌患者分为高剂量组和低剂量组各34例,在静脉滴注治疗卡瑞利珠单抗200 mg/次的基础上,低剂量组和高剂量组分别口服甲磺酸阿帕替尼片250 mg/d、500 mg/d。记录2组治疗1个月后的客观缓解率、治疗期间不良反应发生率及2年总生存率。结果高剂量组客观缓解率为67.65%,高于低剂量组(41.18%,P<0.05);2组疾病控制率比较差无统计学意义(P>0.05)。高剂量组肾性蛋白尿、手足综合征发生率更高(P<0.05)。低剂量组和高剂量组中位总生存期(OS)分别为13个月、17个月,中位无进展生存期(PFS)分别为8个月、9个月,2年总生存率分别为31.25%、45.45%。2组PFS曲线比较差异有统计学意义(P<0.05)。结论晚期肝细胞癌治疗中适量提高阿帕替尼使用剂量有助于提升疗效,但肾性蛋白尿、手足综合征等不良反应发生风险随之升高。

Objective To explore the efficacy and safety of different doses of apatinib combined with karelizumab in the treatment of advanced liver cancer.Methods Sixty-eight patients with advanced hepatocellular carcinoma admitted from October 2017 to October 2020 in Xuancheng Central Hospital were divided into a high-dose group and a low-dose group with 34 patients in each group.On the basis of 200 mg/time of intravenous infusion of carelizumab,the low-dose group and high-dose group took additional 250 mg/d and 500 mg/d of alpatinib mesylate tablets respectively.The objective remission rate,adverse reaction rate and 2-year overall survival rate of the two groups after 1 month of treatment were recorded.Results The objective response rate of the high-dose group was 67.65%,which was higher than that of the low-dose group(41.18%,P<0.05);The difference of disease control rate between the two groups was not statistically significant(P>0.05).The incidence of renal proteinuria and hand-foot syndrome was higher in the high-dose group(P<0.05).The median total survival(OS)was 13 months and 17 months in the low-dose group and high-dose group,and the median progression-free survival(PFS)was 8 months and 9 months,respectively.The total 2-year survival rate was 31.25%and 45.45%,respectively.There was statistically significant difference in PFS curve between the two groups(P<0.05).Conclusion In the treatment of advanced primary hepatocellular carcinoma,appropriately increasing the dosage of apatinib mayl help to improve the efficacy,but the risk of adverse reactions such as renal proteinuria and hand-foot syndrome will be a major concern.