卡瑞利珠单抗联合诱导化疗后放化疗治疗局部晚期鼻咽癌的疗效

Short-term efficacy of camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma

目的探讨卡瑞利珠单抗联合诱导化疗后序贯同步放化疗在局部晚期鼻咽癌患者中的临床效果和安全性。方法前瞻性纳入Ⅲ~IV_(A)期鼻咽癌患者共24例,接受两周期卡瑞利珠单抗(200 mg)联合多西他赛+顺铂诱导化疗(多西他赛75 mg/m^(2)+顺铂25 mg/m^(2)连续3 d),之后接受标准同步放化疗(处方剂量:PGTV、PGTV_(nd)为6996 cGy/33次、PTV1为6006 cGy/33次、PTV2为5096 cGy/28次,同步顺铂化疗,剂量为75 mg/m^(2))。观察患者的近期疗效和不良反应。结果诱导治疗后鼻咽病灶客观缓解率(ORR)为91.6%[完全缓解(CR)45.8%+部分缓解(PR)45.8%];颈部淋巴结ORR为95.8%(CR 4.2%,PR 91.6%)。17例同意复查鼻咽镜,咬检后显示13例获得病理完全缓解。同步放化疗后鼻咽病灶CR为83.3%,PR为16.7%;颈部淋巴结CR为91.7%,PR为8.3%。13例IV_(A)期患者诱导治疗后鼻咽病灶ORR为92.4%,颈部淋巴结ORR为92.4%,均为PR。同步放化疗结束后鼻咽病灶CR为84.6%,PR为15.4%;颈部淋巴结CR为92.3%,PR为7.7%。治疗期间主要不良反应为白细胞、粒细胞减少和贫血以及放射性急性口咽黏膜炎和皮炎、胃肠道反应、乏力、甲状腺功能减退、转氨酶升高以及反应性皮肤毛细血管增生症。结论卡瑞利珠单抗联合诱导化疗序贯同步放化疗用于治疗局部晚期鼻咽癌患者,能获得较高的近期疗效,未增加不良反应发生率,远期疗效值得期待。

Objective To investigate the clinical effect and safety of camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy for patients with locally advanced nasopharyngeal carcinoma(NPC).Methods A total of 24 patients with stageⅢ-IV_(A) NPC were recruited prospectively to receive two cycles of camrelizumab combined with induction chemotherapy(docetaxel 75 mg/m^(2)+cisplatin 25 mg/m^(2) for three consecutive days)followed by concurrent chemoradiotherapy(prescription doses:6996 cGy in 33 fractions for PGTV and PGTV_(nd),6006 cGy in 33 fractions for PTV1,5096 cGy in 28 fractions for PTV2,and concurrent cisplatin chemotherapy with a dose of 75 mg/m^(2)).The short-term efficacy and adverse reactions were evaluated.Results After induction therapy,nasopharyngeal lesions showed an objective response rate(ORR)of 91.6%,including 45.8%of complete response(CR)and 45.8%of partial response(PR);cervical lymph nodes showed an ORR of 95.8%(CR:4.2%;PR:91.6%).Seventeen patients accepted a reexamination under a nasopharyngoscope,and the biting biopsy result indicated that 13 patients among them had complete pathologic response.After concurrent chemoradiotherapy,nasopharyngeal lesions and cervical lymph nodes showed CR rates of 83.3%and 91.7%and PR rates of 16.7%and 8.3%,respectively.After the induction therapy,13 patients with stage IV_(A) NPC had ORR(PR)rates of 92.4%and 92.4%,respectively,at nasopharyngeal lesions and cervical lymph nodes.After concurrent chemoradiotherapy,the patients with stage IV_(A) NPC had CR rates of 84.6%and 92.3%and PR rates of 15.4%and 7.7%,respectively,at nasopharyngeal lesions and cervical lymph nodes.Major adverse reactions include leukopenia,granulopenia,anemia,radioactive acute oropharyngeal mucositis and dermatitis,digestive tract reaction,fatigue,hypothyroidism,aminotransferase elevation,and reactive capillary hyperplasia.Conclusions Camrelizumab combined with induction chemotherapy followed by concurrent chemoradiotherapy can achieve high short-term efficacy for patients with locally advanced nasopharyngeal carcinoma,without increasing the incidence of adverse reactions.Its long-term efficacy deserves further research.