Objective To investigate the clinical efficacy of bevacizumab combined with toripalimab in radiotherapy for patients with advanced esophageal squamous cell carcinoma (ESCC). Methods A retrospective analysis was conducted on the medical records of 120 patients with advanced ESCC in our hospital from June 2020 to June 2023. Based on treatment regimens, the patients were divided into four groups: the control group (radiotherapy), the bevacizumab group (bevacizumab +radiotherapy), the toripalimab group (toripalimab+radiotherapy), and the combined group (bevacizumab+toripalimab +radiotherapy). Each group contained 30 patients, and all received 14 weeks of treatment. Tumor markers, serum levels of gastrin and motilin, immune function indicators, and quality of life scores were compared before and after treatment. Objective response rate (ORR), disease control rate (DCR), and incidence of adverse reactions were also analyzed. Results The combined group showed significantly higher ORR (90.00%) and DCR (96.67%) compared to the control group (ORR: 56.67%, DCR: 80.00%), the bevacizumab group (ORR: 66.67%, DCR: 86.67%), and the toripalimab group (ORR: 70.00%, DCR: 83.33%). The ORR in the combined group was notably superior, and the difference was statistically significant. Prior to treatment, there were no significant differences in tumor markers, serum gastrin and motilin levels, immune function indicators, or Karnofsky Performance Status (KPS) scores among the four groups. After treatment, all groups showed a significant reduction in high mobility group box 1 (HMGB1), carcinoembryonic antigen (CEA), and squamous cell carcinoma antigen (SCC-Ag) levels, while gastrin, motilin levels, CD3+, CD8+ T cell counts, and KPS scores increased significantly, with no significant differences. Compared to the control, bevacizumab, and toripalimab groups, the combined group had significantly lower levels of HMGB1, CEA, SCC-Ag, and CD4+ and CD4+/CD8+ ratios, as well as significantly higher levels of gastrin, motilin, CD3+, and CD8+ T cells and KPS scores. The incidence of adverse reactions in the combined group was significantly lower than in the control, bevacizumab, and toripalimab groups, with statistically significant differences. Conclusion Bevacizumab combined with toripalimab and radiotherapy offers a significant therapeutic advantage for patients with advanced esophageal squamous cell carcinoma, effectively improving objective response rate, disease control rate, immune function, and quality of life, while reducing the incidence of adverse reactions.
Key words
bevacizumab /
toripalimab /
radiotherapy /
advanced esophageal squamous cell carcinoma /
immune function
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References
[1] 方庆亮, 王蕾, 毛广敏, 等. 调强放疗联合替吉奥治疗中晚期食管癌的疗效及对患者细胞免疫功能的影响[J]. 医学综述, 2022, 28(19): 3896-3901.
[2] JIA Y, ZHANG B, QIN Y, et al.Single-Cell Transcriptomic Analysis of Primary and Metastatic Tumor Ecosystems in Esophageal Squamous Cell Carcinoma[J]. Adv Sci (Weinh), 2023, 10(7): 2204-2215.
[3] 闫可, 魏菀怡, 邓文钊, 等. 颈胸上段食管鳞癌根治性同步放化疗远期预后分析及影响因素研究[J]. 中国全科医学, 2023, 26(30): 3785-3790.
[4] 李建军, 张军峰, 牛红卫. 卡瑞利珠单抗联合替吉奥胶囊对晚期食管鳞癌的疗效及安全性研究[J]. 实用临床医药杂志, 2024, 28(12): 36-41.
[5] QIU MZ, OH DY, MOEHLER M, et al.Tislelizumab plus chemotherapy versus placebo plus chemotherapy as first line treatment for advanced gastric or gastro-oesophageal junction adenocarcinoma: RATIONALE-305 randomised, double blind, phase 3 trial[J]. BMJ, 2024, 28(385): 788-796.
[6] 谢永铮, 任学群. 贝伐珠单抗联合FOLFOX治疗晚期转移性结直肠癌的临床疗效及安全性评价[J]. 中国临床药理学杂志, 2015, 31(22): 2208-2210.
[7] 杨毫, 施贵冬, 张程城, 等. 信迪利单抗与替雷利珠单抗在进展期食管鳞状细胞癌新辅助治疗中的疗效及安全性对比[J]. 国际肿瘤学杂志, 2024, 51(4): 210-216.
[8] HALLEMEIER CL, MOUGHAN J, HADDOCK MG, et al.Association of Radiotherapy Duration With Clinical Outcomes in Patients With Esophageal Cancer Treated in NRG Oncology Trials: A Secondary Analysis of NRG Oncology Randomized Clinical Trials[J]. JAMA Netw Open, 2023, 6(4): 2385-2394.
[9] ZHU AX, ABBAS AR, DE GALARETTA MR, et al.Molecular correlates of clinical response and resistance to atezolizumab in combination with bevacizumab in advanced hepatocellular carcinoma[J]. Nat Med, 2022, 28(8): 1599-1611.
[10] 丁婕, 戴旭, 孟宪运, 等. 实体瘤疗效评价标准的研究进展[J]. 中国肿瘤临床与康复, 2015, 22(9): 1150-1152.
[11] WANG FH, ZHANG XT, TANG L, et al.The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2023[J]. Cancer Commun (Lond), 2024, 44(1): 127-172.
[12] 陈海林, 安尼瓦尔·买买提, 张旋, 等. HOTAIR/CSTF2/CD44轴调控食管癌侵袭转移的机制研究[J]. 湖南师范大学学报(医学版), 2023, 20(5): 8-15.
[13] CHEN Y, YU R, LIU Y.Combine radiotherapy and immunotherapy in esophageal squamous cell carcinoma[J]. Crit Rev Oncol Hematol, 2023, 190(6): 1041-1045.
[14] DOKI Y, AJANI JA, KATO K, et al.Nivolumab Combination Therapy in Advanced Esophageal Squamous-Cell Carcinoma[J]. N Engl J Med, 2022, 386(5): 449-462.
[15] TAMIMI A, TAMIMI A, DERAVI N, et al.Monoclonal antibodies for the treatment of squamous cell carcinoma: A literature review[J]. Cancer Rep (Hoboken), 2023, 6(5): 1802-1806.
[16] 周坤, 袁维, 伍静, 等. 疏肝健脾解毒方联合替雷利珠单抗及贝伐珠单抗对晚期肝癌患者的临床疗效[J]. 中成药, 2024, 46(12): 4221-4224.
[17] YAP DWT, LEONE AG, WONG NZH, et al.Effectiveness of Immune Checkpoint Inhibitors in Patients With Advanced Esophageal Squamous Cell Carcinoma: A Meta-analysis Including Low PD-L1 Subgroups[J]. JAMA Oncol, 2023, 9(2): 215-224.
[18] 陈方, 梁海, 程刚, 等. 替雷利珠单抗联合铂类治疗中晚期非小细胞肺癌的近期疗效和安全性研究[J]. 临床和实验医学杂志, 2023, 22(6): 583-587.
[19] 王天, 顾大勇, 刘雅恬, 等. 局部放疗联合全身治疗寡转移食管鳞癌疗效分析[J]. 中华肿瘤防治杂志, 2024, 31(1): 27-32.
[20] ROGERS JE, YAMASHITA K, SEWASTJANOW-SILVA M, et al.Nivolumab combination therapy as first-line treatments for unresectable, advanced or metastatic esophageal squamous cell carcinoma[J]. Expert Rev Anticancer Ther, 2023, 23(6): 565-571.
[21] LUO H, LU J, BAI Y, et al.Effect of Camrelizumab vs Placebo Added to Chemotherapy on Survival and Progression-Free Survival in Patients With Advanced or Metastatic Esophageal Squamous Cell Carcinoma: The ESCORT-1st Randomized Clinical Trial[J]. JAMA, 2021, 326(10): 916-925.
[22] SHEN L, KATO K, KIM SB, et al.Tislelizumab Versus Chemotherapy as Second-Line Treatment for Advanced or Metastatic Esophageal Squamous Cell Carcinoma (RATIONALE-302): A Randomized Phase III Study[J]. J Clin Oncol, 2022, 40(26): 3065-3076.
[23] ZHOU N, LEE KH, PEDROZA C, et al.Bayesian post-hoc analysis of chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus[J]. J Thorac Cardiovasc Surg, 2022, 164(3): 688-693.
[24] 陈慧芳. 卡瑞利珠单抗联合TP方案治疗晚期食管癌的临床研究[J]. 实用癌症杂志, 2023, 38(3): 491-495.
[25] 倪峰, 徐健, 邰国梅, 等. 复方苦参注射液联合放疗治疗老年中晚期食管癌临床疗效及对患者血清CEA, CA199及CA50水平的影响[J]. 湖北中医药大学学报, 2022, 24(1): 38-41.
[26] 王铃燕, 王兴丹, 王向前. 白蛋白结合型紫杉醇联合顺铂同期放射治疗对初治局部晚期食管鳞状细胞癌的疗效及安全性[J]. 临床与病理杂志, 2023, 43(7): 1333-1340.
[27] GUO X, ZHU R, LUO A, et al.EIF3H promotes aggressiveness of esophageal squamous cell carcinoma by modulating Snail stability[J]. J Exp Clin Cancer Res, 2020, 39(1): 175-179.
[28] 刘广国, 税莲, 邓海军, 等. 尼妥珠单抗诱导自噬激活对食管鳞状细胞癌化疗敏感性的作用[J]. 肿瘤药学, 2021, 11(3): 315-319.
[29] AKHTAR J, IMRAN M, WANG G.CRISPR/Cas9-Mediated CtBP1 Gene Editing Enhances Chemosensitivity and Inhibits Metastatic Potential in Esophageal Squamous Cell Carcinoma Cells[J]. Int J Mol Sci, 2023, 24(18): 14030-14033.
[30] KAO WY, SU CW.Outcomes of atezolizumab and bevacizumab for hepatocellular carcinoma: Does age matter[J]. Liver Int, 2022, 42(12): 2597-2598.
[31] LU YX, WANG YJ, XIE TY, et al.Effects of early oral feeding after radical total gastrectomy in gastric cancer patients[J]. World J Gastroenterol, 2020, 26(36): 5508-5519.
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