替雷利珠单抗联合含铂双药方案治疗老年晚期肺腺癌的疗效

Effects of tislelizumab combined with platinum-containing dual-drug regimen in elderly patients with advanced lung adenocarcinoma

目的 探讨替雷利珠单抗联合培美曲赛及卡铂化疗方案治疗晚期肺腺癌老年患者的疗效,及对血清胰岛素样生长因子1(IGF-1)、胰岛素样生长因子结合蛋白3(IGFBP-3)水平的影响。方法 选取2021年7月至2022年12月南京医科大学第四附属医院收治的94例驱动基因阴性的晚期肺腺癌老年患者为研究对象,采用随机数字表法分为化疗组(培美曲赛联合卡铂治疗,n=48)及替雷利珠单抗组(培美曲赛+卡铂+替雷利珠单抗,n=46),以21 d为1个周期,治疗4个周期。记录两组临床疗效及治疗前后的免疫功能[T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))]、血清指标(IGF-1、IGFBP-3)变化,评估不良反应发生情况。结果 替雷利珠单抗组临床疗效优于化疗组,客观有效率明显高于化疗组(58.70%vs 29.17%,χ^(2)=8.329,P<0.01)。治疗4个周期后,两组CD4^(+)、CD4^(+)/CD8^(+)及IGFBP-3水平均较治疗前显著升高(P<0.05),且治疗后替雷利珠单抗组高于化疗组(P<0.05);两组CD8+及IGF-1均较治疗前显著降低(P<0.05),且治疗后替雷利珠单抗组低于化疗组(P<0.05)。两组不良反应以1~2级为主,发生率差异无统计学意义(P>0.05)。结论 替雷利珠单抗联合含铂双药一线治疗老年晚期肺腺癌可提升临床疗效,改善CD4^(+)/CD8^(+)平衡,调节血清IGF-1、IGFBP-3水平,不良反应可控,治疗方案安全、可靠。

Objective To explore the efficacy of tislelizumab combined with pemetrexed and carboplatin chemotherapy in elderly patients with advanced lung adenocarcinoma and its effects on serum insulin-like growth factor 1(IGF-1)and insulin-like growth factor binding protein 3(IGFBP-3)levels.Methods Ninety-four driver gene-negative elderly patients with advanced lung adenocarcinoma admitted to the Fourth Affiliated Hospital of Nanjing Medical University from July 2021 to December 2022 were selected as the study subjects.They were divided into chemotherapy group(pemetrexed combined with carboplatin,n=48)and tislelizumab group(pemetrexed+carboplatin+tislelizumab,n=46)by the random number table method,and both groups were treated for 4 cycles,with 21 days as a cycle.The clinical efficacy,immune function[T lymphocyte subsets(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))]and serum indicators(IGF-1,IGFBP-3)before and after treatment were recorded in both groups,and the adverse reactions were assessed.Results The clinical efficacy and objective response rate(58.70%vs 29.17%,χ^(2)=8.329,P<0.01)in tislelizumab group were significantly higher than those in chemotherapy group.After 4 cycles of treatment,the CD4^(+),CD4^(+)/CD8^(+)and IGFBP-3 levels in both groups were significantly increased compared with those before treatment(P<0.05),and the indicators in tislelizumab group were higher than those in chemotherapy group(P<0.05);CD8^(+)and IGF-1 levels were significantly decreased in both groups compared with those before treatment(P<0.05),and the indicators in tislelizumab group were lower than those in chemotherapy group(P<0.05).Adverse reactions were mainly grade 1-2 in both groups,and there was no significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion The first-line therapy of tislelizumab combined with platinum-containing dual-drug for elderly advanced lung adenocarcinoma can improve the clinical efficacy,improve the balance of CD4^(+)/CD8^(+),regulate the expression of serum IGF-1 and IGFBP-3 levels.The adverse reactions are controllable,and the treatment regimen is safe and reliable.