阿替利珠单抗联合贝伐珠单抗治疗TACE抵抗中晚期肝细胞癌的疗效及安全性分析<sup>★</sup>

doi:10.3969/j.issn.2095-1264.2024.06.12

首页 > 过刊浏览>2024年第6期 >731-737. DOI:10.3969/j.issn.2095-1264.2024.06.12

阿替利珠单抗联合贝伐珠单抗治疗TACE抵抗中晚期肝细胞癌的疗效及安全性分析★
DOI:
                        10.3969/j.issn.2095-1264.2024.06.12
                    
作者:
                        
                        
                    
作者单位:1.陕西省核工业二一五医院 普外二科，陕西 咸阳，712000;2.陕西中医药大学第二附属医院 胃病科， 陕西 咸阳，712099
作者简介:郭栋，男，硕士，主治医师，研究方向为肝胆胃肠肿瘤的早期诊断与治疗。
通讯作者:郑伟，男，主治医师，研究方向为肝胆胃肠疾病的临床与基础研究。
中图分类号:R735.7;R979.5
基金项目:陕西省中医药管理局中医药科研课题（JCMS014）。

Efficacy and safety analysis of atezolizumab combined with bevacizumab in the treatment of TACE-resistant advanced hepatocellular carcinoma^★

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Affiliation:

1.Department of the Second General Surgery, Shaanxi Provincial Nuclear Industry 215 Hospital, Xianyang, 712000, Shaanxi, China;2.Department of Gastroenterology, the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, 712099, Shaanxi, China

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摘要:

目的探讨阿替利珠单抗联合贝伐珠单抗治疗经肝动脉化疗栓塞术（TACE）抵抗的中晚期肝细胞癌（HCC）的疗效及安全性。方法选取2020年1月至2022年12月我院收治的84例TACE抵抗的中晚期HCC患者，根据治疗方法不同分为对照组和试验组，每组42例。在按需行TACE的基础上，对照组采用索拉非尼治疗，试验组采用阿替利珠单抗联合贝伐珠单抗治疗。比较两组患者的疗效、肿瘤标志物和血管生成因子水平、肿瘤无进展生存期（PFS）及不良反应。结果试验组治疗总有效率（73.81%）明显高于对照组（47.62%）（P<0.05）；治疗后，两组患者血清甲胎蛋白（AFP）、血小板衍生生长因子（PDGF）、碱性成纤维细胞生长因子（bFGF）、血管内皮生长因子（VEGF）水平均低于治疗前，且试验组显著低于对照组（P<0.05）；随访9~32个月，试验组患者中位PFS明显长于对照组（P<0.05）。两组不良反应发生率比较，差异无统计学意义（P>0.05），但试验组免疫性皮炎发生率明显高于对照组（P<0.05）。结论阿替利珠单抗与贝伐珠单抗联合疗法对TACE抵抗的中晚期HCC患者疗效显著，能有效降低肿瘤标志物与血管生成因子水平，延长PFS，整体安全性较好。

Abstract:

Objective To investigate the efficacy and safety of atezolizumab combined with bevacizumab in the treatment of transcatheter arterial chemoembolization (TACE)-resistant advanced hepatocellular carcinoma (HCC).Methods A total of 84 patients with TACE-resistant advanced HCC admitted to our hospital between January 2020 and December 2022 were selected, and divided into the control group (n=42) and the test group (n=42) according to different treatment methods. On the basis of on-demand TACE, the control group was treated with sorafenib, while the test group was treated with atezolizumab and bevacizumab. A comparison was made between the two groups, focusing on the curative effects, levels of tumor markers, angiogenic factors, progression-free survival (PFS), and any adverse reactions experienced.Results The test group demonstrated a significantly higher effective treatment rate than the control group (73.81% vs. 47.62%) (P<0.05). After treatment, the serum levels of alpha fetoprotein (AFP), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) in the two groups were lower than those before treatment, and those in the test group were lower than those in the control group (P<0.05). The duration of follow-up in this study ranged from 9 to 32 months, with no patients lost tracking. The median PFS of the test group was 10 months, which was longer than that of the control group (5 months), and the difference was statistically significant (χ²=5.72, P=0.017). The difference between the two groups in the incidence rate of adverse reactions did not reach statistical significance (P>0.05), but the test group exhibited a significantly higher incidence rate of immune dermatitis than the control group (P<0.05).Conclusion The combination therapy of atezolizumab and bevacizumab has a significant effect on patients with TACE-resistant advanced HCC. It can effectively improve the levels of tumor markers and angiogenic factors, prolong the progression-free survival of patients, with relatively good safety at the same time.