中医药联合信迪利单抗注射液转化治疗晚期胃癌1例

摘要/Abstract

摘要： 晚期胃癌患者因对化疗药物、靶向药物耐受性差,优势人群较少等因素,临床疗效亟需提高。近年来,免疫治疗异军突起,最新研究表明,信迪利单抗注射液联合化疗,为晚期胃癌患者的治疗提供了一个新的一线标准治疗方案。现报道1例胃癌晚期患者,通过中医药联合信迪利单抗注射液超前治疗,显著缩小肿瘤、消除转移病灶、使肿瘤降期、创造手术条件;术后继发腹壁转移,继续中医药联合信迪利单抗注射液配合化疗、放疗完成根除治疗,最终实现成功转化和根治。目前该患者病情评估完全缓解（CR）且持续随访中,确诊至末次评估总生存（OS）共计52个月,目前仍健康生存,至今超过60个月,临床效果显著,特此报道,以供参考。

关键词: 晚期胃癌, 信迪利单抗注射液, 免疫治疗, 转化治疗, 中医药

Abstract: Advanced gastric cancer patients urgently need to improve their clinical efficacy due to factors such as poor tolerance to chemotherapy drugs, targeted drugs, and fewer advantageous populations. In recent years, immunotherapy has emerged rapidly, and the latest research shows that the combination of Sintilimab injection and chemotherapy provides a new first-line standard treatment for advanced gastric cancer patients. A case of advanced gastric cancer is reported. Through advanced treatment with traditional Chinese medicine combined with Sintilimab injection, the tumor was significantly reduced, metastatic lesions were eliminated, tumor staging was reduced, and surgical conditions were created; After surgery, secondary abdominal wall metastasis occurred, and traditional Chinese medicine combined with Sintilimab injection combined with chemotherapy and radiotherapy was used to complete eradication treatment, ultimately achieving successful transformation and cure. At present, the patient's condition has been evaluated by CR and continuous follow-up. The diagnosis of OS has lasted for a total of 52 months until the last evaluation, and the patient is still healthy and has survived for over 60 months. The clinical effect is significant, and this report is for reference by colleagues.

Key words: advanced gastric cancer, Sintilimab injection, immunotherapy, transformation therapy, traditional Chinese medicine

中图分类号:

R735

靳永杰, 李雁, 于小伟, 方美花, 许征国, 胡正军, 沈欢, 仝欣. 中医药联合信迪利单抗注射液转化治疗晚期胃癌1例[J]. 中华养生保健, 2024, 42(21): 175-180.

JIN Yong-jie, LI Yan, YU Xiao-wei, FANG Mei-hua, XU Zheng-guo, HU zheng-jun, SHEN Huan, TONG Xin. A Case of Advanced Gastric Cancer Treated with Sintilimab injection[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(21): 175-180.

参考文献

[1] SUNG H, FERLAY J, SIEGEL R L, et al.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA: A Cancer Journal for Clinicians,2021,71(3):209-249.
[2] ITO YURI, MIYASHIRO I, ISHIKAWA T, et al.Determinant factors on differences in survival for gastric cancer between the US and Japan using nationwide databases[J]. Journal of epidemiology,2020,31(4):241-248.
[3] LI K, TIAN H.Development of small-molecule immune checkpoint inhibitors of PD-1/PD-L1 as a new therapeutic strategy for tumour immunotherapy[J]. Journal of drug targeting,2019,27(3):244-225.
[4] GREALLY M, CHOU J F, CHATILA W K, et al.Clinical and Molecular Predictors of Response to Immune Checkpoint Inhibitors in Patients with Advanced Esophagogastric Cancer[J]. Clinical cancer research : An official journal of the American Association for Cancer Research,2019,25(20):6160-6169.
[5] KAWAZOE A, SHITARA K, BOKU N, et al.Current status of immunotherapy for advanced gastric cancer[J]. Japanese journal of clinical oncology,2020,51(1):20-27.
[6] LUCHINI C, BIBEAU F, LIGTENBERG M J L, et al. ESMO recommendations on microsatellite instability testing for immunotherapy in cancer, and its relationship with PD-1/PD-L1 expression and tumour mutational burden: A systematic review-based approach[J]. Annals of oncology : Official journal of the European Society for Medical Oncology,2019,30(8):1232-1243.
[7] 权红良,邓友星,陈香存.信迪利单抗注射液治疗晚期实体肿瘤的临床观察[J].中国医院用药评价与分析,2021,21(07):813-815+819.
[8] VENERITO M, VASAPOLLI R, ROKKAS T, et al. Gastric cancer: Epidemiology, prevention,therapy[J]. Helicobacter,2018,23 Suppl 1:e12518
[9] 胃癌诊治难点中国专家共识(2020版)[J].中国实用外科杂志,2020,40(8):869-904.
[10] JOHNSTON F M, BECKMAN M.Updates on Management of Gastric Cancer[J]. Current oncology reports,2019,21(8):67.
[11] WAGNER A D, SYN N L, MOEHLER M, et al. Chemotherapy for advanced gastric cancer[J]. The Cochrane database of systematic reviews,2017,8:CD004064.
[12] SELIM J H, SHAHEEN S, SHEU W C, et al.Targeted and novel therapy in advanced gastric cancer[J]. Experimental hematology & oncology,2019,8(15_suppl):25.
[13] ZHANG Y, XU X, HU C, et al.Trastuzumab in combination with chemotherapy for HER2-positive metastatic gastric cancer patients underwent conversion therapy[J]. Translational cancer research,2022,11(7):2145-2156.
[14] 肖俊峰,王昌青,王贵和.局部不可切除胃癌的转化治疗[J].中国现代手术学杂志,2021,25(2):101-104.
[15] 丁平安,郭洪海,檀碧波,等.晚期胃癌NIPS转化治疗腹壁化疗港应用经验分享(附视频)[J].社区医学杂志,2021,19(13):779-782.
[16] 王超,高志冬,沈凯,等.转移性胃癌的转化治疗[J].中华普通外科杂志,2022,37(8):561-566.
[17] 施永康,邱华锋,马君,等.Ⅳ期胃癌转化治疗后腹腔镜手术治疗的临床效果[J].中国医师杂志,2022,24(3):330-333.
[18] 吴芳,林文发,蔡徐帆,等.肠内营养支持治疗在晚期胃癌转化治疗中的疗效观察[J].中国医师杂志,2022,24(3):326-329.
[19] 邓薇,张翊乔,靖超,等.卡瑞利珠单抗联合阿帕替尼、白蛋白紫杉醇及替吉奥用于进展期胃癌的转化治疗[J].国际外科学杂志,2022,49(4):242-247,F4.
[20] 吴天峰,林春丽,崔杰.替吉奥+奥沙利铂+阿帕替尼方案对Ⅳ期胃癌患者的转化治疗效果[J].癌症进展,2021,19(23):2428-2431.
[21] 杜成荣,曹齐生,黄志荣,等.甲磺酸阿帕替尼联合SOX方案三药转化治疗在一线治疗失败的晚期胃癌患者中的应用效果[J].中国医药导报,2021,18(32):113-116.
[22] 林文发,吴芳,蔡徐帆,等.阿帕替尼联合SOX方案对胃癌伴腹膜转移患者进行转化治疗的临床疗效[J].中国医师杂志,2022,24(3):341-345.
[23] 叶再生,曾奕,魏晟宏,等.阿帕替尼联合奥沙利铂和替吉奥在胃癌腹膜转移转化治疗中的安全性及近期疗效观察[J].中华胃肠外科杂志,2021,24(3):240-247.
[24] 蔡明志,王学军,刘勇,等.以替吉奥为基础联合阿帕替尼的三药方案在不可切除晚期胃癌转化治疗中的应用[J].中华胃肠外科杂志,2021,24(2):179-184.
[25] 朱小轩,刘海鹏,景钦东,等.SOX方案联合甲磺酸阿帕替尼转化治疗不可切除胃癌2例[J].肿瘤药学,2022,12(2):267-271.
[26] 人源免疫重建PDX模型构建及其在肿瘤免疫治疗中的应用进展[J].中国肿瘤临床,2022,49(15):806.
[27] 孔祥楠,张茹,宋欣新,等.非小细胞肺癌患者肺静脉血循环肿瘤细胞数量及程序性死亡受体配体-1表达与预后的关系[J].中华实用诊断与治疗杂志,2021,35(11):1100-1103.
[28] 周峰,吴骋.抗PD-1/PD-L1抗体药物的全球市场规模影响因素分析及市场预测[J].中国新药杂志,2018,27(6):619-625.
[29] HAN Y, LIU D, LI L.PD-1/PD-L1 pathway: current researches in cancer[J]. American journal of cancer research,2020,10(3):727-742.
[30] 付培彪,吕晶晶,邹明雷,等.信迪利单抗联合EP方案治疗广泛期小细胞肺癌的效果观察[J].中国实用医刊,2021,48(21):90-93.
[31] WANG J, FEI K, JING H, et al.Durable blockade of PD-1 signaling links preclinical efficacy of sintilimab to its clinical benefit[J]. mAbs,2019,11(8):1443-1451.
[32] 张双燕,王童非,叶骉飞,等.信迪利单抗注射液治疗晚期恶性肿瘤的疗效和安全性分析[J].癌症进展,2022,20(10):1035-1037+1041.
[33] 卫春燕,宋丽丽.信迪利单抗联合改良DCF方案治疗晚期胃癌的临床研究[J].检验医学与临床,2022,19(14):1970-1974.
[34] JIANG H, ZHENG Y, QIAN J, et al.Safety and efficacy of sintilimab combined with oxaliplatin/capecitabine as first-line treatment in patients with locally advanced or metastatic gastric/gastroesophageal junction adenocarcinoma in a phase Ib clinical trial[J]. BMC cancer,2020,20(1):760-760.
[35] XU J, JIANG H, PAN Y, et al. Sintilimab plus chemotherapy (chemo) versus chemo as first-line treatment for advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma (ORIENT-16): First results of a randomized, double-blind, phase III study.2021 ESMO, LBA53.
[36] 郑佳彬,王俊江.三药方案围手术期化疗在进展期胃癌/胃食管结合部腺癌的疗效比较[J].循证医学,2021,21(5):269-272.
[37] 汪华. FOLFOX4联合紫衫醇脂质体方案一线治疗中晚期胃癌的疗效对比[J].现代诊断与治疗,2021,32(6):888-889.
[38] 许亚凤,李相勇,王亚萍,等.FOLFOX4联合紫衫醇脂质体与XELOX方案一线治疗晚期胃癌的疗效观察[J].现代消化及介入诊疗,2020,25(4):492-495.
[39] 张喆,陈萍.白蛋白结合型紫杉醇联合替吉奥方案在胃癌术前新辅助化疗中的疗效分析[J].慢性病学杂志,2021,22(12):1789-1794.
[40] 张秋杰,赵海波,于清清.不同一线化疗方案治疗老年晚期胃癌的近期临床疗效观察[J].肿瘤药学,2021,11(6):743-747.
[41] 苏卓彬,李曙光,任惠敏,等.紫杉醇联合卡铂单周化疗方案与奥沙利铂联合卡培他滨方案对Ⅲ期胃癌患者的疗效及安全性比较[J].中国医药,2020,15(10):1567-1571.
[42] 肖博文,范俐娟.FLOT与SOX新辅助化疗方案联合腹腔镜下D2根治术治疗局部进展期胃癌的近期效果比较[J].中国实用乡村医生杂志,2021,28(9):65-68.
[43] 周兆栋. 紫杉醇联合替吉奥方案在进展期胃癌新辅助化疗中的应用[J].中国现代药物应用,2021,15(16):163-165.
[44] 彭巍,谭盐梅,赵晔.紫杉醇联合卡铂单周化疗方案与奥沙利铂联合卡培他滨方案对Ⅲ期胃癌患者的疗效及安全性对比[J].中国处方药,2021,19(6):91-92.
[45] 冉剑波,唐丽君.中医药对恶性肿瘤的临床应用、作用机制及实践的研究进展[J].现代医学与健康研究电子杂志,2023,7(1):123-127.
[46] 何晓玉,田文灏,储真真,等.中医药在肿瘤康复中的临床应用[J].中国临床医生杂志,2022,50(12):1510-1512.