摘要
目的:探讨免疫联合抗血管治疗对比免疫单药治疗在晚期非小细胞肺癌(NSCLC)二线及以上治疗中的临床价值,为NSCLC的二线及以上治疗寻找合适的免疫联合治疗方案。方法:回顾性分析2017年1月至2020年11月该院收治的免疫单药治疗与免疫联合抗血管治疗的晚期NSCLC患者38例,其中免疫单药治疗(单药组)患者20例,免疫联合抗血管治疗(联合组)患者18例。比较两组患者的无进展生存期(PFS)、客观缓解率(ORR)、疾病控制率(DCR)及不良反应。结果:单药组和联合组患者的中位PFS分别为4.84个月(95%CI=3.50个月~6.18个月)和8.13个月(95%CI=5.65个月~10.62个月),联合组患者的中位PFS长于单药组,差异有统计学意义(P=0.009);联合用药方案较单药方案在男性、吸烟、腺癌、程序性死亡受体配体1(PD-L1)表达水平≥1%的患者中的PFS更长(P<0.05),多因素分析显示PD-L1表达水平是影响联合治疗PFS的独立因素。单药组和联合组患者的ORR分别为10.00%(2/20)和27.78%(5/18),联合组患者ORR较单药组有提高,但差异无统计学意义(P=0.158);单药组和联合组患者的DCR分别为65.00%(13/20)和77.78%(14/18),差异无统计学意义(P=0.632)。两组患者的不良反应均可耐受,联合组患者未出现3级及以上的不良反应。结论:免疫联合抗血管治疗可延长二线及以上治疗的晚期NSCLC患者的PFS,PD-L1表达水平是影响联合治疗PFS的独立因素,联合治疗安全可控。
OBJECTIVE:To investigate the clinical value of immunotherapy combined with antiangiogenics compared with immunomonotherapy in the treatment of second-line and above advanced non-small cell lung cancer(NSCLC),so as to find the suitable immunotherapy regimen for second-line and above advanced NSCLC.METHODS:Thirty eight patients with advanced NSCLC received immunomonotherapy or immunotherapy combined with antiangiogenics from Jan.2017 to Nov.2020 were retrospectively analyzed,20 patients were treated with immunomonotherapy(monotherapy group),and 18 patients were treated with immunotherapy combined with antiangiogenics(combined group).Progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR)and adverse drug reactions were observed.RESULTS:The median PFS of monotherapy group and combined group were respectively 4.84 months(95%CI:from 3.50 months to 6.18 months)and 8.13 months(95%CI:from 5.65 months to 10.62 months),the median PFS of combined group was longer than that of monotherapy group,the difference was statistically significant(P=0.009).Compared with monotherapy regimen,PFS in males,patients with smoking,adenocarcinoma,and programmed death receptor ligand 1(PD-L1)expression level≥1%was longer(P<0.05).Multifactor analysis showed that PD-L1 expression level was an independent factor affecting PFS in combination therapy.ORR of patients in the monotherapy group and combined group was respectively 10.00%(2/20)and 27.78%(5/18),and the ORR of the combined group was higher than that in monotherapy group,the difference was not statistically significant(P=0.158).DCR of patients in monotherapy group and combined group was respectively 65.00%(13/20)and 77.78%(14/18),with no statistically significant difference(P=0.632).Adverse drug reactions were tolerated in both groups,and no adverse drug reactions of grade 3 or above occurred in the combined group.CONCLUSIONS:Immunotherapy combined with antiangiogenics can prolong the PFS of advanced NSCLC patients in second-line and above treatment.PD-L1 expression level is an independent factor affecting PFS in combination therapy,and combination therapy is safe and controllable.
作者
高远
刘艳霞
董宇杰
鲁葆华
胡范彬
王群慧
张红梅
张同梅
GAO Yuan;LIU Yanxia;DONG Yujie;LU Baohua;HU Fanbin;WANG Qunhui;ZHANG Hongmei;ZHANG Tongmei(General Department,Beijing Chest Hospital,Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China;Dept.of Pathology,Beijing Chest Hospital,Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China)
出处
《中国医院用药评价与分析》
2024年第3期271-274,277,共5页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
北京市科技计划项目(No.Z211100002921013)。
关键词
非小细胞肺癌
免疫治疗
抗血管治疗
临床疗效
不良反应
Non-small cell lung cancer
Immunotherapy
Antiangiogenics
Clinical efficacy
Adverse drug reactions
