摘要
目的观察卡瑞利珠单抗联合白蛋白紫杉醇单药化疗后序贯放疗在老年局部晚期食管癌患者治疗中的价值。方法回顾性分析2019-05-01-2021-02-20青岛市肿瘤医院收治的56例初治老年(≥70岁)局部晚期食管癌患者,治疗前均行鼻胃营养管置入,并做组织基因检测进行程序性细胞死亡因子-1配体(PD-L1)的综合阳性评分(CPS),采用卡瑞利珠单抗联合白蛋白紫杉醇单药每周疗法,4个周期后序贯应用局部调强适形放疗50~54Gy,其后继续原方案化疗2个周期,并应用卡瑞利珠单抗维持治疗4~9个月。观察近期疗效,包括客观缓解率(ORR)、疾病控制率(DCR)以及不良反应等。结果56例入组患者中位年龄74岁(70~77岁),最终45例患者完成总体治疗,完成率达80.0%,其中完全缓解7例(12.5%),部分缓解24例(42.9%),疾病稳定20例(35.7%),总体ORR为55.4%(31/56),DCR为91.1%(51/56)。对PD-L1表达水平进行分析,CPS<1、1≤CPS<5和CPS≥5组ORR分别为37.8%(14/37)、13/15和4/4,CPS≥1患者ORR获益差异有统计学意义,P=0.001;DCR分别为86.5%(32/37)、15/15和4/4,差异均无统计学意义,P=0.405。不良反应以中性粒细胞减少(29例,51.7%)为主,卡瑞利珠单抗相关的反应性毛细血管增生症发生率偏高(31例,55.2%),但多为1~2级不良反应,3~4级严重不良反应少见。结论对于老年局部晚期食管癌患者,卡瑞利珠单抗联合单药白蛋白紫杉醇序贯放疗的治疗模式近期疗效确切,耐受性好。
Objective To observe the value of camrelizumab combined with albumin-bound paclitaxel and sequential thoracic radiotherapy in the treatment of elderly patients with locally advanced esophageal cancer.Methods The locally advanced esophageal cancer patients over 70years old being admitted in Qingdao Cancer Hospital from May 1,2019to February 20,2021were analyzed retrospectively.All patients received the placement of nasogastric nutrition tubes before treatment,and tissue genetic testing was performed for PD-L1comprehensive positive score(CPS)score.Ccamrelizumab was used every two weeks combined with albumin-bound paclitaxel weekly for 4cycles,and after 4cycles,locally intensity-modulated radiotherapy with total dose of 50-54Gy was applied sequentially,and then the original regimen chemotherapy was continued for 2cycles.Camrelizumab was maintained for 4-9months.The short-term efficacy of the regimen,including objective response rate,disease control rate,and adverse reactions was observed.Results The median age of 56enrolled patients was 74years old(70-77years old),and finally 45patients completed the overall treatment,with a completion rate of 80.0%,7patients had complete response(12.5%),24patients had partial response(42.9%),20patients had stable disease stability(35.7%).The overall objective response rate was 55.4%(31/56),the disease control rate(DCR)was 91.1%(51/56).The analysis of PD-L1showed that the objective response rates(ORR)of CPS<1group,1≤CPS<5group and CPS≥5group were 37.8%(14/37),13/15and 4/4,respectively(P=0.001).There was statistically significant difference in ORR benefit among people with CPS≥1The objective response rate(ORR)benefit of CPS≥1group was significantly different,and the disease control rate The(DCRs of)CPS<1group,1≤CPS<5group and CPS≥5group was were 86.5%(32/37),15/15and 4/4,respectively(P=0.405).Adverse reaction was mainly neutropenia(29patients,51.7%),and the incidence of camrelizumab-related reactive cutaneous capillary endothelial proliferation(RCCEP)was high(31patients,55.2%),but most of them were grade 1-2adverse reactions,and serious adverse reactions of grade 3-4were rare.Conclusions For elderly patients with locally advanced esophageal cancer,the treatment of camrelizumab combined with albumin-bound paclitaxel and sequential thoracic radiotherapy is safe and effective.
作者
梁华
葛明珠
李新
宋琪
王俊杰
韩淑红
古颖春
LIANG Hua;GE Ming-zhu;LI Xin;SONG Qi;WANG Jun-jie;HAN Shu-hong;GU Ying-chun(Qingdao Cancer Hospital,Qingdao 266042,China;Department of Respiratory Medicine,North Hospital Area of Qingdao Central Hospital,Qingdao 266000,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2022年第20期1495-1499,共5页
Chinese Journal of Cancer Prevention and Treatment
关键词
食管癌
免疫检查点抑制剂
序贯放化疗
客观缓解率
疾病控制率
esophageal cancer
immune checkpoint inhibitor
sequential chemoradiotherapy
objective response rate
disease control rate
