Although PD-1 immunotherapy has opened a new model of tumor treatment, and has a good performance in the treatment of non-small cell lung cancer (NSCLC), melanoma, bladder cancer and other cancers, the low efficiency is always PD -1 A weakness that cannot be avoided by immunotherapy. It is for this reason that the exploration of various combination therapies is endless. In this year’s ASCO annual meeting, there are two clinical trials of PD-1 antibody combined with chemotherapy that are worthy of attention: PD-1 antibody combined with chemotherapy is first-line for advanced bowel cancer and gastric cancer, and the control rate is 100% and 92%, respectively! Keytruda combined with chemotherapy as a first-line treatment for advanced bowel cancer, the disease control rate is 100%.
Previous studies have confirmed that Keytruda is particularly sensitive to colorectal cancer with dMMR / MSI-H gene mutations, but this group of patients is relatively small. So, for patients without dMMR gene mutation, how effective is immunotherapy? The clinical trial recruited 30 previously untreated patients with advanced bowel cancer, 11 women and 26 white patients, with a median age of 45 years. Among them, 3 patients belong to MSI-H type, 22 belong to MMR, and the efficacy of 5 patients cannot be evaluated. The treatment regimens received by the patients were: Keytruda, 200 mg, once every 3 weeks; FOLFOX regimen combined with folinic acid, OX 68 mg / m2, folinic acid 400 mg / m2, 5FU 320 mg / m2. The results showed that as of December 29, 2016, within a median follow-up period of 24 weeks, of the 30 patients, 1 patient had complete remission, 15 patients had partial remission, and 14 patients had stable disease. The disease control rate reached 100%. The proportion of treatment-related serious side effects of grades 3-4 was 36.7%. No grade 5 adverse reactions have been found in the study.
Keytruda combined with chemotherapy as a first-line treatment for advanced gastric cancer, the disease control rate is 92%! The results of the first-line treatment of bowel cancer with Keytruda combined with chemotherapy are almost as stunning. The control rate of Keytruda combined with first-line treatment of gastric cancer can reach 92%! A total of 25 patients with advanced gastric cancer were recruited in the trial. Male patients accounted for 64%, Asians accounted for 68%, and PD-L1 positive patients accounted for 64%. The average age of the patients was 64 years. The patient’s dosage is: Keytruda, 200mg, once every 3 weeks; 5-FU, 800mg / m2; cisplatin, 80mg / m2. As of October 19, 2016, during a median follow-up period of 12.2 months, the patient’s effective rate was 60%, and the disease stability rate reached 32%, which means that the disease control rate was as high as 92%. Only 4% of patients have disease progression, and 4% of patients cannot be evaluated for efficacy. The median progression-free survival (PFS) was 6.6 months, and the median overall survival (OS) was 13.8 months.
It is worth mentioning that the side effects of combination therapy are relatively large. 76% of patients had grade 3-4 side effects, and 3 of them stopped treatment due to too much side effects. However, these side effects are not fatal and can be controlled. Therefore, patients should be reminded that although the effect of combined treatment is good, it must be used under the guidance of regular hospitals and qualified doctors. Do not use drugs without authorization.
