Efficacy And Safety Of PD-1/PD-L1 Inhibitors Combined With Molecular Targeted Drugs In The Treatment Of Advanced Liver Cancer

Objective: To investigate the efficacy and safety of PD-1 / PD-L1 inhibitors combined with small molecule targeted drugs in the treatment of advanced HCC.Methods: from January 2019 to December 2019,we collected and recorded the general data,blood routine,biochemical,thyroid function,urine routine and other indicators,image data,and previous treatment of patients with advanced HCC who were treated by PD-1 / PD-L1 inhibitors combined with small molecule targeted drugs in our hospital through telephone consultation,hospital office system and face-to-face inquiry By using SPSS 22.0 software,the data obtained were statistically analyzed,and the total survival curve,progression free survival curve and the incidence of adverse reactions during the treatment were obtained,so as to explore the efficacy and safety of the combined treatment.Results: as of December 2019,46 patients were included in the study.The median follow-up time of all patients was 6.0 months.mRECIST standard was used to evaluate the efficacy of the patients,including 2(4.3%)patients with complete response,12(26.1%)patients with partial response,26(56.6%)patients with stable disease and 6(13%)patients with progressive disease.No treatment discontinuation caused by adverse reactions or death caused by combined treatment.The objective response rate(ORR)was 30.4%,and the disease control rate(DCR)was 87.0% The median progression free survival(mPFS)was 7.0(95% confidence interval,1.6-12.4)months;the median overall survival(mOS)was not reached;the COX proportional risk model was used to analyze the factors that may affect the prognosis.It was found that BCLC stage,ECOG score and child grade may be related to the progression free survival(PFS).According to NCI-CTC 5.0 standards,the most common any-grade adverse events were hypothyroidism in 20 cases(43.5%),hypertension in 18 cases(39.1%),diarrhea in 16 cases(34.8%),palmo-plantar erythrodysaesthesia in 14 cases(30.4%),decreased appetite in 12 cases(26.1%),fatigue in 11 cases(23.9%),cutaneous capillary endothelial proliferation in 9 cases(19.6%),proteinuria in 8 cases(17.4%),elevated aspartate aminotransferase in 7cases(15.2%),,skin rash in 5 cases(10.9%).The adverse events of grade 3 and abovewere Hypothyroidism in 5 cases(10.9%),hypertension in 7 cases(15.2%),diarrhea in 2 cases(4.3%),palmo-plantar erythrodysaesthesia in 2 cases(4.3%),elevated aspartate aminotransferase in 2 cases(4.3%),proteinuria in 1 case(2.2%),decreased appetite in 1 case(2.2%).Conclusion: PD-1 / PD-L1 inhibitors combined with molecular targeted drugs can significantly improve the objective response rate and prolong the progression free survival of patients with advanced HCC,the safety is controllable.