An evaluation of targeted and immunotherapy in patients with hepatocellular carcinoma
Loading...
Date
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Гепатоцеллюлярная карцинома (ГЦК) – наиболее распространённая (около 85% случаев) злокачественная опухоль печени. За последнее время в арсенале врача-онколога появился относительно большой перечень способов лечения гепатоцеллюлярной карциномы. Цель данного исследования оценить алгоритмы противоопухолевой терапии (таргетной и иммунотерапии), применяемые больных с ГЦК.
Для проведения ретроспективного анализа было отобрано 47 историй болезни пациентов, с гистологически подтверждённым диагнозом: гепатоцеллюлярная карцинома. Средний возраст пациентов составил 61,79±12,08, женщины – 40,43% (n=19), мужчины – 59,57% (n=28).
18 пациентов получали иммунотерапию, 29 – таргетную терапию.
В группе иммунной терапии летальный исход был зарегистрирован в 9 случаях (50,00%), в группе таргетной терапии – в 13 (48,28%). Медиана общей выживаемости в первой группе составила – 360 (271; 630) дня, во второй – 540 (345; 555) дней, разница между группами статистически не значима (тест Манна-Уитни, p=0,40). Статистически значимой разницы по частоте летальных случаев, при сравнении двух групп также не выявлено (точный критерий Фишера, p=0,78).
В группе иммунной терапии ответ на применяемую терапию был зарегистрирован в 6 случаях (33,33%), в группе таргетной терапии – в 10 (34,48%), статистически значимой разницы по ЧОО, при сравнении двух групп, не выявлено (точный критерий Фишера, p=0,513)
В группе иммунной терапии прогрессирование гепатоцеллюлярной карциномы было зарегистрировано в 6 случаях (33,33%), в группе таргетной терапии – в 10 (34,48%). Медиана времени до прогрессирования в первой группе составила – 211,00 (58,25; 285,00) дня, во второй – 75,00 (58,50; 230,50) дней. Статистически значимой разницы по частоте прогрессирования случаев, при сравнении двух групп, не выявлено (точный критерий Фишера, p=0,513). Различия по ВДП статистически не значимы (критерий Манна-Уитни, p=0,24).
В группе иммунной терапии токсичность на фоне применяемой терапии была зарегистрирована в 12 случаях (66,67%), в группе таргетной терапии – в 21 (72,41%). Статистически значимой разницы по переносимости терапии, при сравнении двух групп (точный критерий Фишера, p=0,67).
При анализе влияния на проявление токсичности, общую выживаемость, частоту объективного ответа, прогрессирование, время до начала прогрессирование таких факторов как пол, возраст, наличие и топография метастазов, стадия опухолевого процесса по TNM и BCLC, значение онкомаркеров, наличие вирусного гепатита, цирроз и его стадия по Child-Pugh не было выявлено статистически значимой связи (p>0,05).
В данном исследовании была продемонстрирована эффективность таргетной и иммунной терапии. Данные схемы, исходя из полученных результатов, сопоставимы по токсичности, ЧОО, ВДП и ОВ.
Будущие исследования должны продолжить оценку новых терапевтических стратегий гепатоцеллюлярной карциномы в контексте существующих методов лечения и предоставить дополнительную информацию, которая позволит врачу сделать выбор схемы лечения в каждом конкретном случае.
Hepatocellular carcinoma (HCC) is the most common (about 85% of cases) malignant tumor of the liver. Recently, a relatively large list of methods for treating hepatocellular carcinoma has appeared in the arsenal of an oncologist. The purpose of this study is to evaluate the algorithms of anticancer therapy (targeted and immunotherapy) used in patients with HCC. For a retrospective analysis, 47 case histories of patients with a histologically confirmed diagnosis of hepatocellular carcinoma were selected. The average age of patients was 61.79±12.08, women - 40.43% (n=19), men - 59.57% (n=28). 18 patients received immunotherapy, 29 received targeted therapy. In the immune therapy group, lethal outcome was registered in 9 cases (50.00%), in the targeted therapy group - in 13 (48.28%). The median overall survival in the first group was 360 (271; 630) days, in the second - 540 (345; 555) days, the difference between the groups was not statistically significant (Mann-Whitney test, p=0.40). There was also no statistically significant difference in the frequency of lethal cases when comparing the two groups (Fisher's exact test, p=0.78). In the immune therapy group, the response to the applied therapy was registered in 6 cases (33.33%), in the targeted therapy group - in 10 (34.48%) cases, no statistically significant difference in ORR was found when comparing the two groups (exact criterion Fisher, p=0.513) In the immune therapy group, the progression of hepatocellular carcinoma was registered in 6 cases (33.33%), in the targeted therapy group - in 10 (34.48%). The median time to progression in the first group was 211.00 (58.25; 285.00) days, in the second - 75.00 (58.50; 230.50) days. There was no statistically significant difference in the incidence of progression of cases when comparing the two groups (Fisher's exact test, p=0.513). Differences in TRT are not statistically significant (Mann-Whitney test, p=0.24). In the immune therapy group, toxicity against the background of the therapy used was registered in 12 cases (66.67%), in the targeted therapy group - in 21 (72.41%). Statistically significant difference in tolerability of therapy when comparing the two groups (Fisher's exact test, p=0.67). When analyzing the impact on the manifestation of toxicity, overall survival, objective response rate, progression, time to the onset of progression of such factors as gender, age, the presence and topography of metastases, the stage of the tumor process according to TNM and BCLC, the value of tumor markers, the presence of viral hepatitis, cirrhosis and its Child-Pugh stage did not show a statistically significant relationship (p>0.05). This study demonstrated the effectiveness of targeted and immune therapies. These schemes, based on the results obtained, are comparable in terms of toxicity, ORR, TRT and OS. Future studies should continue to evaluate new therapeutic strategies for hepatocellular carcinoma in the context of existing treatments and provide additional information that will allow clinicians to make treatment decisions on a case-by-case basis.
Hepatocellular carcinoma (HCC) is the most common (about 85% of cases) malignant tumor of the liver. Recently, a relatively large list of methods for treating hepatocellular carcinoma has appeared in the arsenal of an oncologist. The purpose of this study is to evaluate the algorithms of anticancer therapy (targeted and immunotherapy) used in patients with HCC. For a retrospective analysis, 47 case histories of patients with a histologically confirmed diagnosis of hepatocellular carcinoma were selected. The average age of patients was 61.79±12.08, women - 40.43% (n=19), men - 59.57% (n=28). 18 patients received immunotherapy, 29 received targeted therapy. In the immune therapy group, lethal outcome was registered in 9 cases (50.00%), in the targeted therapy group - in 13 (48.28%). The median overall survival in the first group was 360 (271; 630) days, in the second - 540 (345; 555) days, the difference between the groups was not statistically significant (Mann-Whitney test, p=0.40). There was also no statistically significant difference in the frequency of lethal cases when comparing the two groups (Fisher's exact test, p=0.78). In the immune therapy group, the response to the applied therapy was registered in 6 cases (33.33%), in the targeted therapy group - in 10 (34.48%) cases, no statistically significant difference in ORR was found when comparing the two groups (exact criterion Fisher, p=0.513) In the immune therapy group, the progression of hepatocellular carcinoma was registered in 6 cases (33.33%), in the targeted therapy group - in 10 (34.48%). The median time to progression in the first group was 211.00 (58.25; 285.00) days, in the second - 75.00 (58.50; 230.50) days. There was no statistically significant difference in the incidence of progression of cases when comparing the two groups (Fisher's exact test, p=0.513). Differences in TRT are not statistically significant (Mann-Whitney test, p=0.24). In the immune therapy group, toxicity against the background of the therapy used was registered in 12 cases (66.67%), in the targeted therapy group - in 21 (72.41%). Statistically significant difference in tolerability of therapy when comparing the two groups (Fisher's exact test, p=0.67). When analyzing the impact on the manifestation of toxicity, overall survival, objective response rate, progression, time to the onset of progression of such factors as gender, age, the presence and topography of metastases, the stage of the tumor process according to TNM and BCLC, the value of tumor markers, the presence of viral hepatitis, cirrhosis and its Child-Pugh stage did not show a statistically significant relationship (p>0.05). This study demonstrated the effectiveness of targeted and immune therapies. These schemes, based on the results obtained, are comparable in terms of toxicity, ORR, TRT and OS. Future studies should continue to evaluate new therapeutic strategies for hepatocellular carcinoma in the context of existing treatments and provide additional information that will allow clinicians to make treatment decisions on a case-by-case basis.