卡瑞利珠单抗或信迪利单抗联合仑伐替尼治疗肝癌的效果及对肿瘤标志物的影响

摘要/Abstract

摘要： 目的探讨卡瑞利珠单抗或信迪利单抗联合仑伐替尼治疗肝癌的效果及对肿瘤标志物的影响。方法选取2018年6月—2021年6月苏北人民医院收治的原发性肝癌患者95例作为研究对象进行回顾性分析,根据治疗方法将患者分为仑伐替尼组33例(仑伐替尼治疗)、卡瑞利珠组30例(卡瑞丽珠单抗联合仑伐替尼)、信迪利组32例(信迪丽单抗联合仑伐替尼),比较三组治疗后临床疗效、毒副不良反应及对患者肝脏生化指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)及总胆红素(TBil)]、肿瘤标志物[甲胎蛋白(AFP)、癌胚抗原(CEA)、α-L-岩藻糖苷酶(AFU)、糖类抗原199(CA199)]的影响。结果卡瑞利珠组、信迪利组临床疗效明显高于仑伐替尼组(P<0.05);治疗后三组ALT、AST和TBil水平明显降低,卡瑞利珠组、信迪利组明显低于仑伐替尼组(P<0.05);治疗后三组AFP、CEA、AFU和CA199水平明显降低,卡瑞利珠组、信迪利组明显低于仑伐替尼组(P<0.05);三组患者毒副不良反应差异无统计学意义(P>0.05)。结论卡瑞利珠单抗或信迪利单抗联合仑伐替尼治疗肝癌能有效提高疗效,改善肝功能,降低肿瘤标志物水平,且安全性好。

关键词: 卡瑞利珠单抗, 信迪利单抗, 仑伐替尼, 肝癌, 免疫治疗

Abstract: Objective To investigate the therapeutic effect of carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer and its influence on tumor markers. Methods Ninety-five patients with primary liver cancer admitted to our hospital from June 2018 to June 2021 were selected as the research objects. According to the treatment method, the patients were divided into lenvatinib group (lenvatinib, 33 cases), carrelizumab group (carrelizumab combined with lenvatinib, 30 cases), and sintilimab group (sintilimab combined with lenvatinib, 32 cases). The clinical therapeutic efficacy, side effects, liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil)] and tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), α-L-fucosidase (AFU), carbohydrate antigen 199 (CA199)] among the 3 groups after treatment were compared. Results The clinical efficacy of carrelizumab group and sintilimab group were significantly higher than lenvatinib group (P<0.05). The levels of ALT, AST and TBil in the 3 groups were all significantly decreased after treatment, the liver function of carrelizumab group and sintilimab group were significantly lower than lenvatinib group (P<0.05). The levels of AFP, CEA, AFU, and CA199 in the 3 groups were significantly decreased after treatment, the tumor markers levels of carrelizumab group and sintilimab group were significantly lower than lenvatinib group (P<0.05). There was no significant difference in side effects among the 3 groups (P>0.05). Conclusion Carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer can effectively improve the therapeutic efficacy and liver function, reduce the levels of tumor markers, with good safety.

Key words: Carrelizumab, Sintilimab, Lenvatinib, Liver cancer, Immunotherapy

杨建奇, 曹文淼, 吴银霞, 殷婷, 邢恩明. 卡瑞利珠单抗或信迪利单抗联合仑伐替尼治疗肝癌的效果及对肿瘤标志物的影响[J]. 肝脏, 2022, 27(10): 1080-1083.

YANG Jian-qi, CAO Wen-miao, WU Yin-xia, YIN Ting, XING En-ming. The therapeutic effect of carrelizumab or sintilimab combined with lenvatinib in the treatment of liver cancer and the influence on tumor markers[J]. Chinese Hepatolgy, 2022, 27(10): 1080-1083.

参考文献

[1] 李友炳,江家骥. 原发性肝癌系统治疗新进展. 肝脏,2021,26:349-352.
[2] 牟迪. 仑伐替尼治疗恶性实体瘤的研究进展. 中国肿瘤生物治疗杂志,2020,27:445-451.
[3] Mocan T, Sparchez Z, Craciun R, et al. Programmed cell death protein-1 (PD-1)/programmed death-ligand-1 (PD-L1) axis in hepatocellular carcinoma: prognostic and therapeutic perspectives.Clin Transl Oncol,2019, 21:702-712.
[4] 黄健翔,骆旭航,龚安安. 卡瑞利珠单抗配合TACE对伴微血管侵犯肝细胞癌患者根治术后血清Egfl7、VEGF、OPN水平及复发率影响的前瞻性研究. 世界华人消化杂志,2021,29:182-189.
[5] 朱丹,李月阳,宋燕青,李艳娇.PD-1抑制剂信迪利单抗的临床研究进展. 中国医院药学杂志,2020,40:120-123.
[6] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版). 中华肝脏病杂志,2020,28:112-128.
[7] Schwartz LH, Seymour L, Litière S, et al. RECIST 1.1-Standardisation and disease-specific adaptations: Perspectives from the RECIST Working Group. Eur J Cancer,2016, 62:138-145.
[8] Chan SL, Yip TC, Wong VW, et al. Pattern and impact of hepatic adverse events encountered during immune checkpoint inhibitors-A territory-wide cohort study. Cancer Med,2020,9:7052-7061.
[9] 朱笑生,刘文超. 原发性肝癌全球流行情况和危险因素的新进展. 现代肿瘤医学,2018,26:163-167.
[10] Suyama K, Iwase H. Lenvatinib: A Promising Molecular Targeted Agent for Multiple Cancers. Cancer Control, 2018, 25:1073274818789361.
[11] Wu X, Gu Z, Chen Y, et al. Application of PD-1 Blockadein Cancer Immunotherapy. Comput Struct Biotechnol J, 2019, 17:661-674.
[12] 李冰,云哲琳,董长城. PD1/PD-L1信号通路相关蛋白在肝癌中的表达及与临床病理特征的关系. 肝脏,2019,24:1449-1450.
[13] 赖奉庭. 卡瑞利珠单抗治疗晚期原发性肝癌临床效果及安全性研究. 山西医药杂志,2021,50:2269-2272.
[14] Waidmann O. Recent developments with immunotherapy for hepatocellular carcinoma. Expert Opin Biol Ther, 2018, 18:905-910.
[15] 徐梓宁,黄敬君,周娟,等. 程序性死亡受体-1单抗在肝动脉化疗栓塞联合分子靶向药物治疗后进展期肝细胞癌的疗效分析. 中华内科杂志,2021,60:630-636.
[16] 赵秋玲,杨琳,谢瑞祥. 9种获批上市的抗PD-1/PD-L1单抗药物的特征综述. 中国药房,2020,31:128-133.
[17] Piñero F, Dirchwolf M, Pess? a MG. Biomarkers in Hepatocellular Carcinoma: Diagnosis, Prognosis and Treatment Response Assessment. Cells, 2020, 9:1370.
[18] 王铮. 血清肿瘤标志物的联合检测在原发性肝癌中的诊断价值. 中华肿瘤防治杂志,2018,25:82+84.