既往免疫治疗失败的晚期胃癌患者再次接受免疫治疗的疗效和安全性
Efficacy and safety of re-immunotherapy in advanced gastric cancer patients who have previously failed immunotherapy
祁清华 1王银华 1王颜 2叶斌1
作者信息
- 1. 华东师范大学附属芜湖医院安徽省芜湖市第二人民医院放疗一科,芜湖 241000
- 2. 华东师范大学附属芜湖医院安徽省芜湖市第二人民医院病理科,芜湖 241000
- 折叠
摘要
目的 评估晚期胃癌患者初次免疫检查点抑制剂(ICIs)治疗进展后,再次接受免疫治疗的疗效和安全性.方法 回顾性分析2019年10月至2022年10月在芜湖市第二人民医院初始免疫治疗进展后,再次接受免疫治疗的17例晚期胃癌患者的临床特征和预后资料.初始免疫治疗方案包括ICIs(帕博利珠单抗、纳武利尤单抗、信迪利单抗、卡瑞利珠单抗、特瑞普利单抗及恩沃利单抗)联合化疗(氟尿嘧啶类、紫杉类、奥沙利铂为主)或抗血管生成药物(阿帕替尼、呋喹替尼).再次接受免疫治疗方案,包括原免疫药物,程序性死亡受体1(PD-1)抗体和程序性死亡受体配体1(PD-L1)抗体间的互换,不同PD-1抗体间的互换.两次免疫治疗间可接受或不接受其他治疗.生存分析采用Kaplan-Meier法.结果 17例晚期胃癌患者的中位总生存时间(OS)为18个月.初始免疫治疗阶段,11例(64.7％)患者获得部分缓解(PR),4例(23.5％)患者获得疾病稳定(SD),中位无进展生存时间(PFS)为6个月.再次接受免疫治疗后,2例(11.8％)患者达PR,8例(47.1％)患者达SD,中位PFS为3个月.对初次免疫治疗最佳疗效达PR者,再次接受ICIs后,疾病控制率(DCR)为81.8％(9例/11例).再次免疫治疗期间,免疫相关不良反应多为1～2级,无患者因严重不良反应而中止治疗.结论 对于晚期胃癌患者初次ICIs治疗,病情进展后,再次接受免疫治疗可能带来一定获益,且治疗安全性较好,是晚期胃癌患者可选择的治疗方案之一.
Abstract
Objective To evaluate the efficacy and safety of re-immunotherapy in advanced gastric cancer patients who have progressed after initial immune checkpoint inhibitors(ICIs)therapy.Methods A retrospective analysis from October 2019 to October 2022 at Wuhu Second People's Hospital of 17 cases of advanced gastric cancer patients who received re-immunotherapy after progression on initial immunotherapy.Initial immunotherapy regimens included ICIs(pembrolizumab,nivolumab,sintilimab,camrelizumab,toripalimab or envafolimab)combined with chemotherapy(fluorouracil,taxus or oxaliplatin)or angiogenesis inhibitors(apatinib,fruquintinib).Received re-immunotherapy included original immunotherapeutic agents,programmed cell death protein 1(PD-1)antibodies,and programmed death-ligand 1(PD-L1)antibodies interchange,and PD-1 antibody interchange.Other therapies were optional between two courses of immunotherapy.Survival analysis used Kaplan-Meier method.Results Median overall survival(OS)of 17 advanced gastric cancer patients was 18 months.During initial immunotherapy,11 patients(64.7％)achieved partial response(PR),and 4 patients(23.5％)achieved stable disease(SD),with median progression-free survival(PFS)of 6 months.After re-immunotherapy,2 patients(11.8％)achieved PR,8 patients(47.1％)achieved SD,with median PFS of 3 months.Disease control rate(DCR)after re-ICIs in patients who responded best to initial immunotherapy was 81.8％(9 out of 11 patients).Most immune-related adverse events during re-immunotherapy were grades 1-2,with no treatment discontinuations due to severe adverse events.Conclusion Received re-immunotherapy may provide benefits with good safety for advanced gastric cancer patients who progressed after initial ICIs therapy,presenting a viable treatment option.
关键词
胃肿瘤/进展期/免疫检查点抑制剂/免疫治疗/再次免疫治疗Key words
Gastric neoplasm/Advanced stage/Immune-checkpoint inhibitors/Immunotherapy/Re-immunotherapy引用本文复制引用
出版年
2024
NETL
NSTL
万方数据