Therapeutic effect of transarterial chemoembolization combined with apatinib on patientswith advanced hepatocellular carcinoma
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摘要:
目的 评价肝动脉化疗栓塞术（transarterial chemoembolization，TACE）联合口服阿帕替尼治疗中晚期肝癌的近期疗效。 方法 收集2016年6月至2016年10月于首都医科大学附属北京友谊医院接受TACE联合口服阿帕替尼250 mg/d治疗的21例中晚期原发性肝癌（hepatocellular carcinoma，HCC）患者的临床资料；采用影像学中最新修订的实体瘤疗效评价标准（modified responseevaluation criteria in solid tumors，mRECIST），回顾性分析联合治疗1个疗程（平均约28 d）后患者的治疗效果，并对不良反应进行分析。 结果 21例患者中，完全缓解（complete response，CR）3例（14.3%），部分缓解（patial response，PR）6例（28.6%），疾病稳定（stable disease，SD）5例（23.8%）。疾病控制率（disease control rate，DCR）为61.9%，客观缓解率（objective rate，ORR）为38.1%。疾病进展（progressive disease，PD）2例（9.5%）。21例患者治疗中出现的不良反应：乏力17例（94.4%），胃肠道症状14例（66.7%），手足综合征4例（19.0%），血压升高4例（19.0%），并出现不同程度的声音嘶哑、头痛头晕、蛋白尿等。 结论 TACE联合阿帕替尼对中晚期原发性肝癌的临床治疗近期效果满意，治疗过程中不良反应发生率较高，需给予积极处理。 Abstract:Objective To evaluate the therapeutic effect of transarterial chemoembolization(TACE)combined with apatinib on patients with advanced hepatocellular carcinoma(HCC). Methods Twenty-one patients were treated with TACE combined with 250 mgof apatinib once a day.Disease classification was assessed by investigators using the modified Response Evaluation Criteria in Solid Tumors(mRECIST).The evaluation period was 28 days. Results The therapeutic effects were classified as follows: 3 patients(14.3%)hadcomplete response, 6 patients(28.6%)had partial response, 5 patients(23.8%)had stable disease, and 2 patients(9.5%)had progressive disease.The disease control rate was 61.9%, and the objective response rate was 38.1%.In patients, the most frequent adverseevents were fatigue(94.4%), anorexia(23.8%), diarrhea(19.0%), hypertension(19.0%), and hand-foot syndrome(19.0%). Conclusion The short-term therapeutic effect revealed that the combination of TACE and apatinib could be a promising treatment for patientswith advanced HCC.Adverse events should be closely monitored and provided with active management. -
Key words:
- hepatocellular carcinoma /
- transarterial chemoembolization /
- targeted therapy /
- apatinib
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图 1 患者男性，36岁，发现HCC 1个月，CT示TACE联合阿帕替尼治疗后肿瘤变化情况
Figure 1. A 36-year-old male patient diagnosed with HCC for 1 month.CTshowed the tumor change after TACE and apatinib treatment
A.Arrow indicates the enhanced tumor in the right liver and the tumorthrombus in the branch of portal vein.Afterward, the patient was treatedwith one course of TACE and apatinib(250 mg/d); B.Follow-up contrastenhancement CT reveals that all target lesions were deposited with goodlipiodol accumulation
图 2 患者男性，57岁，发现HCC3个月余。CT与DSA显示TACE联合阿帕替尼治疗后肿瘤变化情况
Figure 2. A 57-year old male patient diagnosed with HCC for 3 months.CT and DSA showed tumor change after TACE and apatinib treatment
A.Abdominal CT shows a single enhanced lesion(arrow)in the right lobe; B.Abdominal CT shows no enhancement within the lesion(arrow); C.DSApresents the same rich blood supply lesion(arrow).Afterward, the patient was treated with one course of TACE and apatinib(250 mg/d); D.DSA showsthat the tumor stain disappeared(arrow).The case was regarded as CR by mRECIST
表 1 患者一般资料
Table 1. Patient information
表 2 联合治疗后mRESIST评价结果
Table 2. Results of mRESIST after administering the combined treatment
表 3 联合治疗后实验室检查随访结果
Table 3. Laboratory values after administering the combined treatment
表 4 联合治疗中患者出现的不良反应
Table 4. Adverse events of the combined treatment
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