TACE联合卡瑞利珠单抗及阿帕替尼治疗晚期肝细胞癌的临床研究

The clinical effect of TACE combined with Camrelizumab and Apatinib in the treatment of advanced hepatocellular carcinoma

目的经导管肝动脉化疗栓塞(TACE)联合卡瑞利珠单抗及阿帕替尼治疗晚期肝细胞癌(HCC)的临床疗效及安全性。方法衢州市人民医院在2019年3月至2022年3月期间纳入37例晚期HCC患者,进行经导管肝动脉化疗栓塞(TACE)联合免疫治疗(卡瑞利珠单抗)及靶向治疗(阿帕替尼)的联合治疗,记录患者治疗前的血液指标、肿瘤分期及影像学特征,随访治疗后患者的血液指标及影像学复查结果,以及治疗过程中出现的不良反应。通过疾病客观缓解率(ORR)、疾病控制率(DCR)、疾病无进展生存期(PFS)和总体生存期(OS)分析联合治疗的临床疗效,Kaplan-Meier绘制相应的生存曲线;通过不良反应评估联合治疗的安全性。结果37例晚期HCC患者接受联合治疗,其中5例失访,9例死亡;ORR和DCR分别为48.65%(18/37)和75.68%(28/37),PFS为9.5个月,OS为12.2个月。卡瑞利珠单抗及阿帕替尼治疗相关不良事件24例(64.86%),无治疗相关死亡病例。结论本研究初步表明,TACE联合免疫治疗(卡瑞利珠单抗)及靶向治疗(阿帕替尼)治疗晚期HCC可以改善患者的生存期,疾病控制率高,且不增加药物不良反应发生率。

Objective To analyze the clinical efficacy and safety of TACE combined with Camrelizumab and Apatinib in the treatment of advanced hepatocellular carcinoma(HCC).Methods Between Mar.2019 and Mar.2022,37 patients with advanced HCC were enrolled in the study.Patients received transcatheter arterial chemoembolization(TACE)combined with immunotherapy(Camrelizumab)and targeted therapy(Apatinib).The patient’s blood indicators,tumor stage,and imaging features before treatment were recorded;the patient’s blood indicators and imaging findings after treatment,as well as any adverse reactions occurred during the treatment process were followed-up.The clinical efficacy was analyzed by objective response rate(ORR),disease control rate(DCR),progression free survival time(PFS),and overall survival time(OS),and the corresponding survival curves were drawed by Kaplan-Meier analysis;the safety of combined therapy was evaluated by adverse reactions.Results Among 37 advanced HCC patients,5 cases were lost during follow-up,and 9 cases died.The ORR and DCR were 48.65%(18/37)and 75.68%(28/37),respectively;with 9.5 months for PFS and 12.2 months for OS.Camrelizumab and Apatinib treatment-related adverse events occurred in 24 cases(64.86%),and no treatment-related deaths occurred.Conclusion This preliminary study shows that,for treatment of advanced HCC,the combination of TACE,immunotherapy(Camrelizumab)and targeted therapy(Apatinib)can improve patient’s survival time,achieve high tumor control rates and low incidence rate of adverse drug reactions.