基于FOLFIRI的肝动脉输注化疗作为二线和连续治疗晚期肝内胆管癌的有效性和安全性:一项真实世界的研究。

IF 2.7 4区 医学 Q2 Medicine Canadian Journal of Gastroenterology and Hepatology Pub Date : 2022-09-26 eCollection Date: 2022-01-01 DOI:10.1155/2022/9680933
Peixin Huang, Xiaoyong Huang, Yingting Zhou, Guohuan Yang, Qiman Sun, Guoming Shi, Yi Chen
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引用次数: 5

摘要

目的:肝内胆管癌(iCCA)是一种预后差且治疗有限的原发性肝脏恶性肿瘤。顺铂联合吉西他滨是标准的一线化疗方案;然而,仍然没有强有力的证据表明二线和连续治疗。虽然初步证据表明精确治疗或免疫治疗在一部分患者中起着至关重要的作用,但基因变化率相对较低。本研究探讨了吉西他滨和铂联合靶向和免疫治疗难治性cca失败后,基于FOLFIRI的肝动脉输注化疗(HAIC)的二线和后续治疗。方法:纳入诊断病理证实的晚期iCCAs患者,这些患者至少在吉西他滨/铂双药和/或其他全身化疗联合靶向治疗和免疫检查点抑制剂方面进展。所有患者均通过HAIC输注5-氟尿嘧啶/亚叶酸钙联合伊立替康(FOLFIRI),直至病情进展或出现不可接受的毒性。主要目标是治疗的可行性,次要目标是疾病控制率(DCR)和6个月生存率。结果:共有9例iCCA患者在2020年12月至2021年5月期间接受治疗;2例远处转移,7例局部淋巴结转移并侵犯门静脉或肝静脉。在6/9的患者中,HAIC作为二线治疗,而在3/9的患者中,HAIC作为第三或连续治疗。患者平均接受2.90±1.69周期的HAIC。客观有效率为22.2%;疾病控制率为55.5% (5/9);中位无进展生存期为5个月;6个月生存率为66.7%(6/9)。结论:我们的研究结果提供了初步证据,证明基于FOLFIRI方案的HAIC对于一些既往治疗后进展的患者是有效和安全的。因此,HAIC可能是晚期CCAs的一种有前途和有价值的补充治疗,作为二线和连续治疗。否则,HAIC与精准医疗的结合可能会提高临床效益(临床注册号:2021BAT4857)。
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The Efficacy and Safety of Hepatic Arterial Infusion Chemotherapy Based on FOLFIRI for Advanced Intrahepatic Cholangiocarcinoma as Second-Line and Successive Treatment: A Real-World Study.

Objective: Intrahepatic cholangiocarcinoma (iCCA) is a primary liver malignancy with a poor prognosis and limited treatment. Cisplatin with gemcitabine is used as the standard first-line chemotherapy regimen; however, there is still no robust evidence for second-line and successive treatments. Although preliminary evidence suggests a vital role of precision therapy or immunotherapy in a subset of patients, the gene alteration rate is relatively low. Herein, we explored the second-line and successive treatments using hepatic arterial infusion chemotherapy (HAIC) based on FOLFIRI after the failure of gemcitabine and platinum combined with target and immunotherapy in refractory CCAs.

Methods: Advanced patients with iCCAs confirmed by diagnostic pathology, who progressed at least on a gemcitabine/platinum doublet and/or other systemic chemotherapy combined with target therapy and immune checkpoint inhibitor, were included. All patients received infusional 5-fluorouracil/leucovorin with irinotecan (FOLFIRI) via HAIC until progression or unacceptable toxicity. The primary objective was the feasibility of treatment, with secondary objectives of disease control rate (DCR) and 6-month survival rate.

Results: A total of 9 iCCA patients treated between Dec 2020 and May 2021 were enrolled; 2 patients suffered from distant metastasis, while 7 had local lymph node metastasis and portal vein or hepatic vein invasion. HAIC was delivered as second-line therapy in 6/9 patients, while a third or successive therapy in 3/9 patients. The patients accepted an average of 2.90 ± 1.69 cycles of HAIC. The objective response rate was 22.2%; the disease control rate was 55.5% (5/9); median progression-free survival was 5 months; and 6-month survival rate was 66.7% (6/9).

Conclusions: Our results provide preliminary evidence that HAIC based on FOLFIRI regimen is efficient and safe in some patients progressing after previous treatment. Therefore, HAIC may be a promising and valuable complementary therapy for advanced CCAs as a second-line and successive therapy. Otherwise, the combination of HAIC with precision medicine may improve clinical benefits (clinical registration number: 2021BAT4857).

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来源期刊
CiteScore
4.80
自引率
0.00%
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0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
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