李涛, 陶然, 张帆, 刘婷婷, 张素洁, 胡毅. 化疗联合免疫检查点抑制剂对局部晚期或转移性胃和胃-食管结合部癌患者的疗效及安全性分析[J]. 解放军医学院学报, 2020, 41(4): 315-320. DOI: 10.3969/j.issn.2095-5227.2020.04.001
引用本文: 李涛, 陶然, 张帆, 刘婷婷, 张素洁, 胡毅. 化疗联合免疫检查点抑制剂对局部晚期或转移性胃和胃-食管结合部癌患者的疗效及安全性分析[J]. 解放军医学院学报, 2020, 41(4): 315-320. DOI: 10.3969/j.issn.2095-5227.2020.04.001
LI Tao, TAO Ran, ZHANG Fan, LIU Tingting, ZHANG Sujie, HU Yi. Effectiveness and safety of chemotherapy combined with immune checkpoint inhibitors for patients with advanced gastric cancer or gastric-esophageal junctional cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2020, 41(4): 315-320. DOI: 10.3969/j.issn.2095-5227.2020.04.001
Citation: LI Tao, TAO Ran, ZHANG Fan, LIU Tingting, ZHANG Sujie, HU Yi. Effectiveness and safety of chemotherapy combined with immune checkpoint inhibitors for patients with advanced gastric cancer or gastric-esophageal junctional cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2020, 41(4): 315-320. DOI: 10.3969/j.issn.2095-5227.2020.04.001

化疗联合免疫检查点抑制剂对局部晚期或转移性胃和胃-食管结合部癌患者的疗效及安全性分析

Effectiveness and safety of chemotherapy combined with immune checkpoint inhibitors for patients with advanced gastric cancer or gastric-esophageal junctional cancer

  • 摘要:
      目的  探索晚期胃和胃-食管结合部癌(gastric cancer or gastroesophageal junction cancer,GC/GEJC)患者化疗联合免疫治疗的临床特点及预期生存。
      方法  收集解放军总医院第一医学中心肿瘤内科2015年5月- 2019年5月治疗的晚期GC/GEJC患者。37例化疗患者为化疗组,采用以氟尿嘧啶(5-FU/卡培他滨/替吉奥)联合铂类或紫杉类的双药化疗,34例接受化疗联合免疫检查点(PD-1)抑制剂纳武单抗(Nivolumab)或派姆单抗(Pembrolizumab)的患者为联合组。
      结果  联合组和化疗组中位无进展生存期(progression-free survival,PFS)分别为3.93个月(95%CI:1.56 ~ 6.30)和4.97个月(95%CI:3.36 ~6.58)(P=0.242),中位总生存期(overall survivsal,OS)分别为14.37个月(95%CI:8.17 ~ 20.57)和12.52个月(95%CI:9.82 ~ 15.22)(P=0.101),客观缓解率为23.5%和18.9%(P=0.634),疾病控制率为79.4%和75.7%(P=0.707)。两组药物临床安全性良好,不良反应均以Ⅰ~Ⅱ级为主。
      结论  化疗联合免疫治疗对于晚期GC/GEJC患者有一定的临床获益,需进一步探索治疗策略及筛选免疫治疗的优势人群。

     

    Abstract:
      Objective  To explore the clinical features and survival of patients with advanced gastric cancer or gastroesophageal junctional cancer (GC/GEJC) treated by chemotherapy plus immunotherapy.
      Methods  From May 2015 to May 2019, patients with advanced GC/GEJC who were treated in the department of oncology, the first medical center of Chinese PLA General Hospital were included in our study, with 37 patients treated with chemotherapy (fluorouracil/capecitabine/tegafur combined with platinum- or taxane-based drugs) as chemotherapy group, and another 34 patients treated with chemotherapy combined with immune checkpoint inhibitors (PD-1, Nivolumab or Pembrolizumab) as combination group. Clinical outcomes were observed and compared between the two groups.
      Results  The progression-free survival (PFS) was 3.93 months (95% CI: 1.56-6.30) in the combination group and 4.97 months (95% CI: 3.36-6.58) in the chemotherapy group (P=0.242); and the overall survival (OS) was 14.37 months (95% CI: 8.17-20.57) and 12.52 months (95% CI: 9.82-15.22) (P=0.101); ORR was 23.5% and 18.9% (P=0.634), DCR was 79.4% and 75.7% (P=0.707). Mild (GradeⅠ-Ⅱ) adverse reactions were found in the two groups.
      Conclusion  Chemotherapy combined with immunotherapy has certain clinical benefits for patients with advanced GC / GEJC, and further exploration of treatment strategies and screening of target population for immunotherapy are still needed.

     

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