免疫檢查點抑制劑治療合并乙型肝炎或丙型肝炎的晚期非小細胞肺癌的安全性及療效分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

陳澄 ¹ , 何方凱 ² , 沈續瑞 ¹ , 黃建安 ¹ ,  管小俊 ¹

1. ;
2. ;

Corresponding?author：

管小俊, Email: gxj309@126.com

Keywords：

非小細胞肺癌; 乙型病毒性肝炎; 丙型病毒性肝炎; 免疫檢查點抑制劑

DOI：

10.7507/1671-6205.202206049

Video：

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目的探討合并乙型肝炎或丙型肝炎的晚期非小細胞肺癌（non-small cell lung cancer，NSCLC）免疫檢查點抑制劑（immune checkpoint inhibitors，ICIs）治療的安全性和療效。方法回顧性分析5例合并乙型肝炎或丙型肝炎的NSCLC，觀察谷丙轉氨酶（alanine aminotransferase，ALT）水平、病毒載量和總生存期。結果 1例活動性乙型肝炎和1例活動性丙型肝炎啟動ICIs治療時，ALT升高，加用抗病毒和保肝治療，ALT即恢復正常。2例活動性和1例慢性乙型肝炎ICIs治療，ALT持續正常水平。2例完全緩解，3例部分緩解，目前死亡2例，最長總生存期35.7個月，其余3例仍在隨訪中。結論乙型肝炎或丙型肝炎不影響ICIs在NSCLC中的治療地位，包括在部分NSCLC的一線治療，全程監測肝功能和病毒拷貝數，推薦聯合抗病毒治療（特別對合并乙型肝炎），個體化調整抗病毒時機及療程。

Citation： 陳澄, 何方凱, 沈續瑞, 黃建安, 管小俊. 免疫檢查點抑制劑治療合并乙型肝炎或丙型肝炎的晚期非小細胞肺癌的安全性及療效分析. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(8): 587-591. doi: 10.7507/1671-6205.202206049 Copy

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15.	Kothapalli A, Khattak MA. Safety and efficacy of anti-PD-1 therapy for metastatic melanoma and non-small-cell lung cancer in patients with viral hepatitis: a case series. Melanoma Res, 2018, 28(2): 155-158.
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18.	He MK, Peng C, Zhao Y, et al. Comparison of HBV reactivation between patients with high HBV-DNA and low HBV-DNA loads undergoing PD-1 inhibitor and concurrent antiviral prophylaxis. Cancer Immunol Immunother, 2021, 70(11): 3207-3216.
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1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin, 2018, 68(1): 7-30.
2. Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet, 2017, 389(10066): 255-265.
3. Borghaei H, Gettinger S, Vokes EE, et al. Five-year outcomes from the randomized, phase Ⅲ trials CheckMate 017 and 057: nivolumab versus docetaxel in previously treated non-small-cell lung cancer. J Clin Oncol, 2021, 39(7): 723-733.
4. Herbst RS, Garon EB, Kim DW, et al. Five year survival update from KEYNOTE-010: pembrolizumab versus docetaxel for previously treated, programmed death-ligand 1-positive advanced NSCLC. J Thorac Oncol, 2021, 16(10): 1718-1732.
5. Polaris Observatory Collaborators. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol, 2018, 3(6): 383-403.
6. Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol, 2017, 2(3): 161-176.
7. Cui FQ, Shen LP, Li L, et al. Prevention of chronic hepatitis B after 3 decades of escalating vaccination policy, China. Emerg Infect Dis, 2017, 23(5): 765-772.
8. Hei FX, Ye SD, Ding GW, et al. Epidemiological analysis on reported hepatitis C cases in China from 2012 to 2016. Biomed Environ Sci, 2018, 31(10): 773-776.
9. 周巧, 余荷, 梁宗安. 免疫檢查點抑制劑導致免疫相關性肺炎. 中國呼吸與危重監護雜志, 2021, 20(10): 753-756.
10. 周永召, 李為民. 肺癌免疫檢查點抑制劑治療的不良反應及其防治. 中華結核和呼吸雜志, 2020, 43(2): 91-95.
11. Larrubia JR, Moreno-Cubero E, Lokhande MU, et al. Adaptive immune response during hepatitis C virus infection. World J Gastroenterol, 2014, 20(13): 3418-3430.
12. Balmasova IP, Yushchuk ND, Mynbaev OA, et al. Immunopathogenesis of chronic hepatitis B. World J Gastroenterol, 2014, 20(39): 14156-14171.
13. Zhu AX, Finn RS, Edeline J, et al. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial. Lancet Oncol, 2018, 19(7): 940-952.
14. El-Khoueiry AB, Sangro B, Yau T, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet, 2017, 389(10088): 2492-2502.
15. Kothapalli A, Khattak MA. Safety and efficacy of anti-PD-1 therapy for metastatic melanoma and non-small-cell lung cancer in patients with viral hepatitis: a case series. Melanoma Res, 2018, 28(2): 155-158.
16. Pertejo-Fernandez A, Ricciuti B, Hammond SP, et al. Safety and efficacy of immune checkpoint inhibitors in patients with non-small cell lung cancer and hepatitis B or hepatitis C infection. Lung Cancer, 2020, 145: 181-185.
17. Zhang XY, Tian D, Chen Y, et al. Association of hepatitis B virus infection status with outcomes of non-small cell lung cancer patients undergoing anti-PD-1/PD-L1 therapy. Transl Lung Cancer Res, 2021, 10(7): 3191-3202.
18. He MK, Peng C, Zhao Y, et al. Comparison of HBV reactivation between patients with high HBV-DNA and low HBV-DNA loads undergoing PD-1 inhibitor and concurrent antiviral prophylaxis. Cancer Immunol Immunother, 2021, 70(11): 3207-3216.
19. Wuyts L, Janssens A, Vonghia L, et al. Nivolumab and anti-HCV activity, a case report. Acta Clin Belg, 2021, 76(5): 392-396.
20. Fukuda R, Sugawara S, Kondo Y. Immune checkpoint inhibitor can reduce HCV-RNA without liver damage. Intern Med, 2020, 59(18): 2245-2248.

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免疫檢查點抑制劑治療合并乙型肝炎或丙型肝炎的晚期非小細胞肺癌的安全性及療效分析

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