5种程序性细胞死亡蛋白1抑制剂的Mini卫生技术评估

目的：通过对纳武利尤单抗、帕博利珠单抗、特瑞普利单抗、信迪利单抗、卡瑞利珠单抗这5种程序性细胞死亡蛋白1（programmed cell death protein 1，PD1）抑制剂进行Mini卫生技术评估，以期为药品遴选、药品安全合理使用提供依据。方法：本文从必要性、有效性、安全性、经济性、国家医保药物、国家基本药物、一致性评价、贮藏条件、有效期、全球使用情况和企业信誉度共11个方面对5种PD1抑制剂进行Mini卫生技术评估。结果：基于上述评估标准，5种PD1抑制剂的评分在58~75分之间。安全性上，PD1抑制剂的免疫相关性不良反应，尤其是心肌炎与神经系统症状在临床应用中应密切关注。结论：Mini卫生技术评估在多维度评估药品，能为医院药品遴选、安全合理使用提供依据，有一定的推广价值。     

Clinical Activity of Ipilimumab Plus Nivolumab in Patients With Metastatic Non–Clear Cell Renal Cell Carcinoma

IntroductionIpilimumab plus nivolumab has been approved for intermediate- and poor-risk metastatic renal cell carcinoma (RCC). However, the activity in non–clear cell RCC (nccRCC) is unknown.Patients and MethodsPatients from Cleveland Clinic and the University of Texas Southwestern who had received ipilimumab plus nivolumab for metastatic nccRCC from October 2017 to May 2019 were retrospectively identified. Ipilimumab plus nivolumab was administered in accordance with the CHECKMATE 214 trial. Imaging was obtained at baseline and every 12 weeks. The baseline patient characteristics, objective response per Response Evaluation Criteria in Solid Tumors, version 1.1, and treatment-related adverse events (TRAEs) per Common Terminology Criteria for Adverse Events, version 5.0, were analyzed.ResultsEighteen patients were identified. The median age was 59 years (range, 32-81 years), 77.8% were men, and the Eastern Cooperative Oncology Group performance status was 0 (38%) or 1 (50%). The median treatment duration was 2.4 months (range, 0.7-12.3 months). The non–clear cell histologic types included 6 papillary, 5 chromophobe, 3 unclassified, 2 adenocarcinoma of renal origin, 1 translocation, and 1 medullary. Most had an intermediate (66%) or poor (22%) International Metastatic Database Consortium risk. The best objective response included 6 partial responses (PRs; 33.3%) and 3 with stable disease (16.7%). Of the patients with a PR, the median time to the best response was 3.0 months, and median duration of the PR was 4.3 months. The median progression-free survival was 7.1 months. All-grade TRAEs were noted in 11 patients (61.1%) and included colitis (22%), hepatotoxicity (16%), rash (11%), and fatigue (11%). Eleven patients (61%) had TRAEs requiring high-dose glucocorticoids (> 40 mg of prednisone equivalent daily).ConclusionsIpilimumab plus nivolumab demonstrated objective responses and notable toxicity in patients with nccRCC.     

PD-1/PD-L1信号通路在肝移植免疫应答中的作用

原发性肝癌（肝癌）是肝移植主要适应证之一,但术后肝癌复发严重影响肝移植的长期疗效。程序性细胞死亡蛋白1（PD-1）是一种免疫抑制分子,PD-1/程序性细胞死亡蛋白配体1（PD-L1）信号通路的激活在移植物免疫耐受中发挥重要作用。近年来,以PD-1/PD-L1抑制剂为代表的免疫检查点抑制剂已成为治疗晚期肝癌病人的有效手段之一,但能否用于肝移植受者仍存在较大的争议,其有效性和安全性仍有待研究。本文对PD-1/PD-L1在移植肝组织的表达、PD-1/PD-L1诱导移植免疫耐受的机制以及PD-1/PD-L1抑制剂在肝癌肝移植中的临床应用做一综述。     

Current advances in Hodgkin’s lymphoma

Hodgkin’s lymphoma is a highly treatable malignancy. It has high cure rates yet there are many patients who relapse or are refractory to treatment. Traditionally, treatment has been with conventional chemotherapy; however, the development of brentuximab vedotin and immune checkpoint inhibitors has revolutionized the care of Hodgkin’s lymphoma. This is a review of the current advances in the management of Hodgkin’s lymphoma and a review of ongoing clinical trials in the field.