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中华介入放射学电子杂志 ›› 2024, Vol. 12 ›› Issue (04) : 289 -295. doi: 10.3877/cma.j.issn.2095-5782.2024.04.001

专题研究·呼吸介入

载药微球支气管动脉化疗栓塞术治疗非小细胞肺癌的研究进展
崔伟1, 李静2, 陈晓明1, 张靖1, 邓屹3, 许荣德1,()   
  1. 1.510080 广东广州,南方医科大学附属广东省人民医院(广东省医学科学院)微创介入科
    2.510080 广东广州,南方医科大学附属广东省人民医院(广东省医学科学院)呼吸与危重症医学科
    3.650093 云南昆明,昆明理工大学医学院,云南省第一人民医院呼吸与危重症医学科
  • 收稿日期:2024-05-08 出版日期:2024-11-25
  • 通信作者: 许荣德
  • 基金资助:
    国家重点研究发展计划(2023YFC2507104)国家自然科学基金(82102163)2024年度基础与应用基础研究专题(优秀博士“续航”项目) (2024A04J2459)

Research progress of drug-eluting beads bronchial arterial chemoembolization in the treatment of nonsmall cell lung cancer

Wei Cui1, Jing Li2, Xiaoming Chen1, Jing Zhang1, Yi Deng3, Rongde Xu1,()   

  1. 1.Department of Interventional Radiology,Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences),Southern Medical University,Guangdong Guangzhou 510080
    2.Department of Pulmonary and Critical Care Medicine,Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences),Southern Medical University,Guangdong Guangzhou 510080
    3.Department of Pulmonary and Critical Care Medicine,The First People's Hospital of Yunnan Province,Medical School of Kunming University of Science and Technology,Yunnan Kunming 650093,China
  • Received:2024-05-08 Published:2024-11-25
  • Corresponding author: Rongde Xu
引用本文:

崔伟, 李静, 陈晓明, 张靖, 邓屹, 许荣德. 载药微球支气管动脉化疗栓塞术治疗非小细胞肺癌的研究进展[J]. 中华介入放射学电子杂志, 2024, 12(04): 289-295.

Wei Cui, Jing Li, Xiaoming Chen, Jing Zhang, Yi Deng, Rongde Xu. Research progress of drug-eluting beads bronchial arterial chemoembolization in the treatment of nonsmall cell lung cancer[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(04): 289-295.

目前传统化疗、靶向治疗以及免疫治疗是不可切除性中晚期非小细胞肺癌(non small cell lung cancer,NSCLC)的标准治疗方案,但其疗效已达到瓶颈。支气管动脉化疗栓塞术(bronchial arterial chemoembolization,BACE)是作为一种较成熟的姑息性微创治疗手段,在提高肿瘤局部化疗药物浓度、减轻全身副反应等方面具有明显优势。近年来随着栓塞材料的发展,药物洗脱微球(drug-eluting beads,DEB),也称为载药微球,通过加载化疗药物使肿瘤内较长时间地、稳定地维持化疗药物的高浓度,从而进一步提高BACE的治疗效果。文章将通过对载药微球BACE(drug-eluting beads BACE,D-BACE)加载的药物、栓塞终点、获益人群以及临床研究进展进行综述,并探讨D-BACE治疗NSCLC目前存在的问题和未来的研究方向。

Currently, traditional chemotherapy, targeted therapy, and immunotherapy are the standard treatment options for inoperable advanced non-small cell lung cancer (NSCLC). However, their efficacy has reached a plateau. Bronchial arterial chemoembolization (BACE) is considered a relatively mature palliative minimally invasive treatment modality, which has distinct advantages in increasing the local concentration of chemotherapy drugs and reducing systemic side effects. In recent years, with the development of embolic materials, drug-eluting beads (DEB), also known as drug-loaded microspheres, have been used to load chemotherapy drugs, allowing for a prolonged and stable maintenance of high drug concentrations within the tumor. This further enhances the therapeutic effect of BACE. This article aims to review the drugs loaded onto drug-eluting beads BACE (D-BACE), the endpoints of embolization, the beneficiary population, and the clinical research progress and explore the current issues and future directions of D-BACE therapy for NSCLC.

表1 载药微球加载抗肿瘤药物种类和剂量的选择
表2 目前主要的D-BACE治疗NSCLC的单臂临床研究(截至2024年4月)
表3 目前主要的D-BACE治疗NSCLC的比较研究(截至2024年4月)
作者 组别 病例数 入组人群 化疗药物 肿瘤反应和疗效
黄锐等,2020[32] D-BACE+化疗 30 不可切除肺鳞癌 吉西他滨、顺铂 ORR 76.7%∶50.0%,P<0.005
化疗 30 OS 21∶13个月(P=0.029)
Fu等,2022[29] D-BACE 14 肺癌咯血 吉西他滨 ORR 61.5%∶23.5%;OS无差异
cBACE 22
Shang等,2022[14] D-BACE 30 Ⅱ~Ⅳ期标准治疗失败或不耐受或拒绝的肺癌 阿霉素、吡柔比星 6个月PFS率 87.5%∶57.1%,P=0.045
BAI 30 6个月OS率 87.5%∶52.4%,P=0.024
Liu等,2021[22] D-BACE+肋间动脉灌注化疗 17 NSCLC合并难治性恶性胸腔积液 表柔比星、培美曲塞、卡铂、吉西他滨 PFS 7.0∶4.0个月,P=0.037
化疗 19 OS 13.4∶7.0个月,P=0.002
Liu等,2021[33] D-BACE+化疗 23 ⅢB~Ⅳ期腺癌和鳞癌 表柔比星、培美曲塞、卡铂、吉西他滨 ORR 47.8%∶19.0%,P=0.044
化疗 21 培美曲塞、卡铂、吉西他滨 D-BACE组PFS、OS均优于化疗组,P均<0.05
Xu等,2022[16] D-BACE+微波消融 28 标准治疗失败或不耐受NSCLC 吉西他滨、奈达铂、紫杉醇、吡柔比星 PFS 7.0∶4.0个月(P=0.037)
D-BACE 49 OS 8.0∶8.0个月(P=0.318)
Yu等,2023[2] D-BACE 12 Ⅲ~Ⅳ期NSCLC 顺铂 ORR 50%∶31.0%,P= 0.010
cBACE 29 多西他赛、顺铂、吉西他滨 PFS 6.95∶3.2个月;P=0.005
OS 28.5∶22.5个月,P=0.020
Xu等,2023[30] D-BACE/BAI联合免疫 27 不可切除难治性NSCLC 吉西他滨、紫杉醇、奈达铂 PFS 12.0∶3.0个月(P<0.001)
BACE/BAI 57 OS 27.0∶8.0个月(P<0.001)
He等,2023[34] D-BACE 20 标准治疗失败后的晚期肺鳞癌 奈达铂、吉西他滨 PFS 4.3∶3.2个月(P=0.030)
cBACE 16 OS 12.6∶8.14个月(P=0.007)
Lai等,2024[31] D-BACE+化疗 41 Ⅲ~Ⅳ肺鳞癌 吉西他滨、顺铂 PFS 8∶6个月(P=0.015)
化疗 95 OS 19∶14个月(P=0.015)
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