pembrolizumab联合DC-CIK细胞治疗晚期肝细胞癌1例

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL
BioMedicine-Taiwan Pub Date : 2023-09-01 eCollection Date: 2023-01-01 DOI:10.37796/2211-8039.1414
Shao M Huang, Long-Bin Jeng, Woei-Cherng Shyu, Hung-Yao Chen
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引用次数: 0

摘要

背景:近年来,免疫疗法已成为治疗晚期HCC的一种很有前途的方法。免疫检查点抑制剂和免疫细胞疗法有几项临床试验和荟萃分析,但缺乏这两种疗法结合的临床证据。病例描述:一名患有慢性乙型肝炎相关肝硬化的66岁男子在医院急诊科抱怨急性腹痛。在检查中,他的腹部右上象限有一个明显的肿块。腹部计算机断层扫描显示右叶有一个大肿瘤,大小13厘米,17厘米,右门静脉血栓形成。甲胎蛋白(AFP)水平为30905 mg/dL。因此,该患者被诊断为BCLC C期肝细胞癌(HCC)。他接受了经动脉化疗栓塞(TACE)、腹部放射治疗、尼沃单抗和乐伐替尼。他的疾病一直得到控制,直到两年后,疾病发展为多发性肺转移,他的AFP水平从1000左右上升到17000 ng/ml。在这个阶段,他于2022年1月接受了新的联合免疫治疗。他首先使用pembrolizumab(100 mg),AFP水平每天下降600 ng/ml。然后,他在使用pembrolizumab两周后接受DC-CIK细胞治疗,AFP水平降至每天900 ng/ml。不幸的是,治疗后出现了严重的肺炎和张力性肺气肿。该患者否认接受进一步治疗,并平静地去世。结论:先前的体内研究发现,联合免疫疗法可以改善小鼠模型中的肿瘤控制。此外,在以前的临床研究中,AFP水平可能是肿瘤反应的替代标志物。因此,我们认为AFP水平下降得更快是检查点抑制剂与细胞治疗在HCC治疗中协同作用的临床证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Combination treatment of pembrolizumab with DC-CIK cell therapy for advanced hepatocellular carcinoma: A case report.

Combination treatment of pembrolizumab with DC-CIK cell therapy for advanced hepatocellular carcinoma: A case report.

Combination treatment of pembrolizumab with DC-CIK cell therapy for advanced hepatocellular carcinoma: A case report.

Combination treatment of pembrolizumab with DC-CIK cell therapy for advanced hepatocellular carcinoma: A case report.

Background: Recently, immunotherapy has emerged as a promising method for advanced HCC treatment. There are several clinical trials and meta-analyses of immune checkpoint inhibitors and immune cell therapy, but clinical evidence on the combination of these two therapies is lacking.

Case description: A 66-year-old man with chronic hepatitis B-related cirrhosis complained of acute abdominal pain in an emergency department of a hospital. On exams, there was a palpable mass in the right upper quadrant of his abdomen. Contrast-enhanced abdominal computed tomography showed a large tumor in the right lobe, 13 cm × 17 cm in size, and right portal vein thrombosis. The alpha-fetoprotein (AFP) level was 30,905 mg/dL. Therefore this patient was diagnosed with BCLC stage C hepatocellular carcinoma (HCC). He underwent trans-arterial chemo-embolization (TACE), abdominal radiotherapy, nivolumab, and lenvatinib. His disease had been under control until two years later, the disease progressed with multiple lung metastases, and his AFP level rose from around 1000 to 17,000 ng/ml. At this stage, he underwent new combination immunotherapy in January 2022. He used pembrolizumab (100 mg) first, and the AFP level decreased by 600 ng/ml daily. Then he received DC-CIK cell therapy two weeks after using pembrolizumab, and the AFP level declined to 900 ng/ml a day. Unfortunately, severe pneumonitis and tension pneumothorax developed after therapy. The patient denied undergoing further treatment and expired peacefully.

Conclusion: The previous in-vivo study found that combination immunotherapy can improve tumor control in the mice model. Besides, in previous clinical studies, the level of AFP may be a surrogate marker of tumor response. Therefore we thought the more rapidly declined level of AFP was the clinical evidence of the synergistic effect of checkpoint inhibitors combined with cell therapy in HCC treatment.

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来源期刊
BioMedicine-Taiwan
BioMedicine-Taiwan MEDICINE, GENERAL & INTERNAL-
CiteScore
2.80
自引率
5.90%
发文量
21
审稿时长
24 weeks
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