程序性死亡受体-1/程序性死亡受体-配体1抑制剂联合不同方案抗癌治疗的相关不良事件发生率及其严重程度分级

Incidence and severity grading of treatment-related adverse event associated with programmed death-1/programmeddeath-ligand 1 inhibitors combined with various anticancer regimens

  • 摘要: 目的 分析程序性死亡受体-1/程序性死亡受体-配体1(PD-1/PD-L1)抑制剂联合不同方案抗癌治疗的相关不良事件(TRAE)发生率及其严重程度分级。方法 回顾性选取以PD-1/PD-L1抑制剂为基础治疗方案的肿瘤患者356例为研究对象。统计PD-1/PD-L1抑制剂联合不同方案抗癌的不良反应发生情况。结果 PD-1/PD-L1抑制剂联合不同抗癌方案的356例患者发生TRAE 332例次,其中疲乏、胃肠道不良反应占比最高,分别为31.93%(106/332)、20.78%(69/332)。皮肤相关不良反应(3~12周)、胃肠道不良反应(5~10周)先出现; 发热(10~30周)、肺炎(12~32周)出现时间较晚,观察时间跨度最大。PD-1/PD-L1抑制剂联合细胞毒性T淋巴细胞相关蛋白4(CTLA-4)的总TRAE发生率最低(85.71%, 36/42), 联合含铂双药化疗的总TRAE发生率最高(96.88%, 155/160)。PD-1/PD-L1抑制剂联合放疗的3~5级TRAE发生率最低(10.53%, 6/57), 联合血管内皮生长因子/血管内皮生长因子受体(VEGF/VEGFR)靶向药的3~5级TRAE发生率最高(44.64%, 25/56)。不同肿瘤间的TRAE发生率及严重程度分级比较,差异无统计学意义(P>0.05)。结论 不同抗癌方案联合PD-1/PD-L1抑制剂时, TRAE总体发生率较高,其中联合CTLA-4的TRAE发生率相对最低,联合放疗的TRAE的症状相对较轻。

     

    Abstract: Objective To analyze the incidence and severity grading of treatment-related adverse event (TRAE) associated with programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors combined with various anticancer regimens. Methods A total of 356 tumor patients treated with PD-1/PD-L1 inhibitors were retrospectively selected as the study objects. The occurrence of adverse reactions in patients treated with PD-1/PD-L1 inhibitors combined with different anticancer regimens was recorded and analyzed. Results Among the 356 patients treated with PD-1/PD-L1 inhibitors in combination with various anticancer regimens, 332 times of TRAEs were observed. Fatigue and adverse gastrointestinal reactions were the most prevalent, accounting for 31.93% (106/332) and 20.78% (69/332) respectively. Skin-related adverse reactions (appearing within 3 to12 weeks) and gastrointestinal adverse reactions (5 to 10 weeks) occurred first, while fever (10 to 30 weeks) and pneumonia (12 to 32 weeks) presented later, with the longest observation time span. The lowest overall incidence of TRAE was observed in the combination of PD-1/PD-L1 inhibitors with cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitors (85.71%, 36/42), while the highest was in the combination with platinum-based doublet chemotherapy (96.88%, 155/160). The incidence of grade 3 to 5 TRAEwas lowest in the combination of PD-1/PD-L1 inhibitors with radiotherapy (10.53%, 6/57) and highest in the combination with vascular endothelial growth factor/vascular endothelial growth factor receptor (VEGF/VEGFR) targeted therapy (44.64%, 25/56). There was no significant difference in the incidence and severity of TRAE among different tumors (P>0.05). Conclusion When different anti-cancer regiments combined with PD-1/PD-L1 inhibitors, the overall incidence of TRAE is higher, among which the incidence of TRAE combined with CTLA-4 is relatively lowest, and the symptoms of TRAE combined with radiotherapy are relatively mild.

     

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