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[其他] 接受PD-1抑製劑並同時預防病毒的高HBV-DNA和低HBV-DNA負荷患者 [复制链接]

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才高八斗

1
发表于 2021-4-5 20:18 |只看该作者 |倒序浏览 |打印
Comparison of HBV reactivation between patients with high HBV-DNA and low HBV-DNA loads undergoing PD-1 inhibitor and concurrent antiviral prophylaxis
Min-Ke He #  1 , Chuan Peng #  2 , Yang Zhao #  1 , Run-Bin Liang #  1 , Zhi-Cheng Lai  1 , Anna Kan  1 , Qi-Jiong Li  1 , Wei Wei  1 , Yao-Jun Zhang  1 , Min-Shan Chen  1 , Rong-Ping Guo  1 , Ming Shi  3
Affiliations
Affiliations

    1
    Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.
    2
    Department of Ultrasonography, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
    3
    Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China. [email protected].

#
Contributed equally.

    PMID: 33813646 DOI: 10.1007/s00262-021-02911-w

Abstract

Background: Programmed cell death protein-1 (PD-1) inhibitor is recommended to treat advanced hepatocellular carcinoma (HCC). However, the safety of PD-1 inhibitor in patients with high HBV-DNA load is unknown because of the potential risk of hepatitis B virus (HBV) reactivation. This study was to compare the HBV reactivation between patients with low HBV-DNA loads and high HBV-DNA loads undergoing antiviral prophylaxis and PD-1 inhibitor.

Methods: This was a retrospective study including consecutive hepatitis B surface antigen-positive HCC patients who received PD-1 inhibitor and concurrent antiviral prophylaxis for prevention of clinical hepatitis. Patients were divided into low HBV-DNA group (low group, ≤ 500 IU/ml) and high HBV-DNA group (high group, > 500 IU/ml) according to the baseline HBV-DNA level. The incidences of HBV reactivation, HBV-associated hepatitis, and PD-1 inhibitor disruption were compared between the two groups.

Results: Two hundred two eligible patients were included: 94 in the low group and 108 in the high group. Seven patients (5 in the low group and 2 in the high group) developed HBV reactivation, and all recovered from HBV reactivation and HBV-associated hepatitis. The incidence of HBV reactivation in the two groups was low (5.3% vs 1.9%, P = 0.34). There was also no difference in the incidence of HBV-associated hepatitis (P = 0.56), or PD-1 inhibitor disruption (P = 0.82). The multivariable analysis showed PD-1 inhibitor with hepatic arterial infusion chemotherapy was the only significant risk factor for HBV reactivation (P = 0.04) and hepatitis (P = 0.002).

Conclusion: With concurrent antiviral prophylaxis, HBV-DNA load higher than 500 IU/ml should not be a contraindication for PD-1 inhibitor.

Keywords: Antiviral prophylaxis; Hepatic arterial infusion chemotherapy; Hepatitis B virus reactivation; Hepatocellular carcinoma; Programmed cell death protein-1 inhibitor.

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才高八斗

2
发表于 2021-4-5 20:18 |只看该作者
接受PD-1抑製劑並同時預防病毒的高HBV-DNA和低HBV-DNA負荷患者的HBV活化
何敏克#1,川鵬#2,楊昭#1,梁潤斌#1,賴志成1,安娜安娜1,李啟瓊1,魏薇1,張耀軍1,陳敏珊1郭榮平1明師3
隸屬關係
隸屬關係

    1個
    中山大學腫瘤學中心肝膽腫瘤科,華南腫瘤學國家重點實驗室,腫瘤醫學協同創新中心,中國廣州510060。
    2個
    中山大學腫瘤學中心超聲科,華南腫瘤學國家重點實驗室,腫瘤醫學協同創新中心,中國廣州。
    3
    中山大學腫瘤學中心肝膽腫瘤科,華南腫瘤學國家重點實驗室,腫瘤醫學協同創新中心,中國廣州510060。 [email protected]


貢獻均等。

    PMID:33813646 DOI:10.1007 / s00262-021-02911-w

抽象的

背景:推薦使用程序性細胞死亡蛋白1(PD-1)抑製劑治療晚期肝細胞癌(HCC)。然而,由於乙型肝炎病毒(HBV)再次激活的潛在風險,因此尚不清楚PD-1抑製劑在高HBV-DNA負荷患者中的安全性。這項研究旨在比較接受抗病毒預防和PD-1抑製劑的低HBV-DNA負荷和高HBV-DNA負荷患者的HBV活化。

方法:這是一項回顧性研究,包括連續接受PD-1抑製劑的乙型肝炎表面抗原陽性的HCC患者,同時進行了抗病毒藥物的預防,以預防臨床肝炎。根據基線HBV-DNA水平,將患者分為低HBV-DNA組(低組,≤500 IU / ml)和高HBV-DNA組(高組,> 500 IU / ml)。比較了兩組的HBV激活,HBV相關肝炎和PD-1抑製劑破壞的發生率。

結果:包括222名符合條件的患者:低組94例,高組108例。七名患者(低組5例,高組2例)發生了HBV激活,並且全部從HBV激活和HBV相關肝炎中康復。兩組的HBV再激活發生率較低(5.3%比1.9%,P = 0.34)。 HBV相關肝炎(P = 0.56)或PD-1抑製劑破壞(P = 0.82)的發生率也沒有差異。多變量分析顯示,PD-1抑製劑與肝動脈灌注化療是HBV激活(P = 0.04)和肝炎(P = 0.002)的唯一重要危險因素。

結論:同時進行抗病毒預防,HBV-DNA負荷高於500 IU / ml不應作為PD-1抑製劑的禁忌證。

關鍵詞:預防病毒;肝動脈灌注化療;乙型肝炎病毒重新激活;肝細胞癌;程序性細胞死亡蛋白1抑製劑。

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美女勋章 维基大牛 旺旺勋章 驴版 翡翠丝带 守护天使 健康之翼 幸福风车 游山玩水 红粉佳人

3
发表于 2021-4-8 19:23 |只看该作者
现在医生都推荐靶向药和PD1,如果使用这些药以后,后面的治疗路还有吗?还有多少人起作用,有数据或文章吗?能否让我们战友们阅读,可以少走弯路,谢谢!
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