ABSTRACT
Objective:To evaluate the efficacy and safety of transhepatic arterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKI) and programmed death-1 (PD-1) inhibitors in the treatment of patients with initially unresectable hepatocellular carcinoma.Methods:The clinical data of 42 patients with initially unresectable hepatocellular carcinoma who were admitted to the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were included. There were 31 males and 11 females, with a median age of 56 years old (range, 45-72 years old). All patients received TACE+ TKI+ PD-1 inhibitor combined treatment. The systemic treatment cycles were calculated by the regimen of immunotherapy. The timing of local treatment depends on tumor size, blood supply and treatment response. Patients were followed up through hospitalization, outpatient visits and telephone review. The Kaplan-Meier curves were obtained for survival analysis.Results:The dosing cycle to achieve optimal imaging response in the patients was 4 (3, 7) [ M( Q1, Q3)], with a systemic treatment time of 141 (65, 194) d [ M( Q1, Q3)] and 2 (1, 3) times [ M( Q1, Q3)] of local treatments. All patients were evaluated by modified response evaluation criteria in solid tumors criteria after treatment, including nine patients with complete response (CR), 21 with partial response, eight with stable disease, and four with progressive disease. Objective response rate and disease control rate were 71.4% (30/42) and 90.5% (38/42), respectively. Treatment-related adverse reactions occurred in 85.7% (36/42) of patients and grade Ⅲ or Ⅳ adverse reactions occurred in 16.7% (7/42). There was no level Ⅳ adverse reactions. All adverse reactions were controlled after dose reduction and symptomatic treatment. Thirteen patients (31.0%, 13/42) redeemed resectable after treatment and underwent radical surgery. Seven patients had pathological CR after surgery. In two patients, the pathological residual cancer tissue was less than 10%. The cumulative overall survival rates of the 42 patients at 6 months, 1 year, 1.5 years after treatment were 100%, 91.7%, and 65.0%, respectively. The postoperative 1-year survival rate of patients undergoing surgery after successful conversion was 83.3%. Conclusion:This study preliminarily showed the safety and efficacy of TACE, TKI, and PD-1 inhibitor combined therapy in patients with initially unresectable hepatocellular carcinoma.
ABSTRACT
OBJECTIVE：To provide reference for individualized treatment of patients with Neuroleptics-induced malignant syndrome（NMS）. METHODS ：A patient with NMS related to antipsychotics was admitted to our hospital in Sept. 19th 2018. Clinical pharmacists provided pharmaceutical care throughout the whole process ，and put forward suggestions for medication. Through literature review ，clinical pharmacists summarized the clinical manifestations ，risk factors ，pathogenesis，diagnosis and therapeutic drugs of NMS. RESULTS & CONCLUSIONS ：Based on the history of antipsychotic drug use ，the characteristic clinical manifestations of NMS and laboratory examination ，the clinical pharmacist proposed that the patient suffered from antipsychotic drug-related NMS ，and the doctor adopted the suggestions. In the course of treatment ，the clinical pharmacist suggested that the subhibernating mixture should be stopped ；Bromocriptine mesylate tablets should be used in combination with continuous hypothermia instrument for physical cooling ，and the treatment course should be at least 10 days according to drug use before admission and medication plan after admission. The doctor adopted the suggestion. The symptoms began to relieve on the third day ，and the symptoms basically disappeared on the 10th day ，then the patient was discharged on the 13th day. The clinical manifestations of NMS were high fever ，myotonia，mental state change ，autonomic nervous disorder ，creatine phosphokinase and leukocyte increase etc. ；risk factors included drug factors ，demographic factors ，genetic and etc. ；the pathogenesis may be associated with dopaminergic receptor block and musculoskeletal fiber toxicity ；the identification diagnosis was based on clinical manifestation，including the onset time ，neuromuscalar reactivity ，remission time ，etc.；the commonly used drugs were bromocriptine mesylate and dantraline.