Analysis Of The Safety And Effectiveness Of PD-1 Inhibitor Combined With Targeted Drugs Compared With Targeted Drugs Or PD-1 Inhibitor In The Treatment Of Advanced HCC

Objective: Compare the efficacy and safety of PD-1-inhibitors combined with molecular Molecularly targeted drug in the treatment of advanced hepatocellular carcinoma with PD-1-inhibitors alone or molecular molecularly targeted drug alone.Methods: A retrospective analysis was performed on patients with advanced hepatocellular carcinoma diagnosed and admitted to The Affiliated Hospital of QingHai University from September 2018 to September 2021.A total of 59 eligible patients were included according to inclusion and exclusion criteria,including 21 patients in the PD-1-inhibitors combined with molecularly targeted drug group(combined group)and 16 patients in the PD-1-inhibitors group.There were 22 cases in the targeted drug group.Collect patient clinical data and other information through hospital inpatient system.Follow-up was conducted at an interval of two weeks.Efficacy and safety were evaluated according to response evaluation criteria in solid tumor 1.1(RECIST1.1)and common terminology criteria for adverse events 5.0(CTCAE 5.0).The primary outcome measures included median progression-free survival(m PFS),median overall survival(m OS)and adverse reactions,while the secondary outcome measures included objective response rate(ORR)and local control rate(DCR).Results: 1.Median progression-free survival(m PFS)was 7.6 months(95%CI: 6.0-9.2)in the combination group,4.8 months(95%CI: 3.4-6.2)in the PD-1-inhibitors group,and 4.2 months(95%CI: 3.2-5.8)in the targeted group,P =0.048.Median overall survival(OS)was 14.6 months(95%CI: 10.6-18.2)in the combination group,10.4 months(95%CI: 6.2 to 14.8)in the PD-1-inhibitors group,and 8.5months(95%CI: 5.3-12.0)in the targeted drug group,P =0.021.The difference was statistically significant.2.Objective response rate(ORR)was higher in combination group than in targeted drug group and PD-1 group(47.6%vs 22.7%vs 18.8%,X2=4.572,P=0.102).The disease control rate(DCR)in combination group was higher than that in targeted drug group and PD-1 group(80.9%vs 54.5%vs 56.2%,X2=3.905,P=0.142).Multivariate Cox analysis showed that BCLC stage,Child grade of liver function,large vessel invasion and extrahepatic metastasis may affect m PFS,and BCLC stage and extrahepatic metastasis are independent prognostic factors.3.Occurrence of adverse reactions: Incidence of adverse reactions: In the combination group,11 cases(52.3%)of 21 patients had adverse reactions of varying degrees;Adverse reactions occurred in 10 of 22 patients(45.5%)in the targeted drug group.Adverse reactions occurred in 9 of 16 patients(56.2%)in the anti-PD-1 mab group.There was no significant difference in the incidence of adverse reactions between groups(P > 0.05)Conclusion: The efficacy of anti-PD-1 monoclonal antibody combined with Molecularly targeted drug in the treatment of advanced hepatocellular carcinoma is superior to that of Molecularly targeted drug alone or anti-PD-1 monoclonal antibody alone,which can prolong the survival time of patients.Drug combination did not increase the incidence of adverse reactions,and the safety was controllable.