| 免疫检查点抑制剂治疗尿路上皮癌的临床经验 |
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| 引用本文： | 王喆,吕程程,付水,毕缓,付成,曾宇. 免疫检查点抑制剂治疗尿路上皮癌的临床经验[J]. 中国肿瘤临床, 2019, 46(24): 1271-1275. DOI: 10.3969/j.issn.1000-8179.2019.24.125 |
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| 作者姓名： | 王喆 吕程程 付水 毕缓 付成 曾宇 |
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| 作者单位： | 中国医科大学肿瘤医院泌尿外科, 辽宁省肿瘤医院泌尿外科(沈阳市 110042) |
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| 摘 要： | 目的 探讨使用免疫检查点抑制剂（immune checkpoint inhibitors，ICIs）治疗尿路上皮癌的临床有效性与安全性。 方法 回顾性分析2016年7月至2019年4月32例于辽宁省肿瘤医院使用ICIs治疗尿路上皮癌患者的临床资料。 结果 32例患者中4例完全缓解（complete remission，CR）、7例部分缓解（partial remission，PR）、5例疾病稳定（stable disease，SD）、9例疾病进展（progressiondisease，PD）、7例尚未评估。总客观有效率（overall response rate，ORR）为44.0%（11/25），总疾病控制率（disease control rate，DCR）为64.0%（16/25）。至少经一种含铂类化疗失败患者的ORR为33.3%（5/15），未经铂类化疗患者ORR达60.0%（6/10）。患者最多接受23个周期的ICIs治疗、约15个月，中位治疗周期为6个周期、约3.5个月。使用ICIs治疗患者通常耐受性良好，常见的免疫相关不良事件（immune-related adverse events，irAEs）为乏力、皮疹、甲减等。32例患者中5例出现irAEs，行静脉滴注皮质类固醇治疗。 结论 ICIs用于铂类化疗失败的局部晚期或转移性尿路上皮癌疗效明确，对于不能耐受或不愿意接受化疗的患者，或不适合手术的原发性尿路上皮癌患者，一线使用ICIs也是临床中可行的治疗方案，对irAEs需早期识别和给予持续治疗。
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| 关 键 词： | 免疫检查点抑制剂 尿路上皮癌 免疫相关不良事件 |
| 收稿时间： | 2019-10-10 |
Immune checkpoint inhibitors for the treatment of urothelial carcinoma: preliminary clinical experience |
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| Affiliation: | Department of Urology, Cancer Hospital of China Medical University/Department of Urology, Liaoning Cancer Hospital&Institute(Shenyang Liaoning 110042, China |
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| Abstract: | Objective To investigate the clinical efficacy and safety of immune checkpoint inhibitors (ICIs) in the treatment of urothelial carcinoma. Methods Clinical data of 32 patients with urothelial carcinoma treated with ICIs at the Department of Urology of Liaoning Cancer Hospital & Institute from July 2016 to April 2019 were retrospectively analyzed. Results Overall, the objective response rate (ORR) and disease control rate were 44% (11/25) and 64% (16/25), respectively. Complete response, partial response, stable disease, progressive disease, and lack of evaluations were found in 4, 7, 5, 9, and 7 patients, respectively. The ORR was 33.3% in patients who had received cisplatin-based chemotherapy and 60% for chemotherapy-naive patients. All patients received up to 23 cycles of treatment over 15 months, with a median treatment period of 3.5 months, which included six cycles. The most common adverse events related to ICI treatment (irAEs) in this group were fatigue, rash, and hypothyroidism. Among 32 patients, 5 (16%) received systemic corticosteroids because of irAEs. Conclusions Second-line treatment is beneficial for unresectable local or metastatic urothelial carcinoma. For patients who might not tolerate or are unwilling to receive chemotherapy, the first-line application of ICI therapy is feasible. However, ICIs are generally well-tolerated by patients. Careful surveillance for irAEs is necessary, and early identification and continued administration of corticosteroids are important to avoid lethal events caused by irAEs. |
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