厄洛替尼挽救治疗吉非替尼治疗失败的晚期非小细胞肺癌疗效观察  

Evaluation of erlotinib as a salvage treatment for non-small-cell lung cancer(NSCLC)patients after gefitinib failure

作　　者：罗大先[1] 龙建林[1] 丘金凤[1] 余敏[1] 邹炳文[1] 周麟[1] 卢铀[1] 黄媚娟[1] 

机构地区：[1]四川大学华西医院肿瘤中心胸部肿瘤科,成都610041

出　　处：《重庆医学》2011年第20期1997-1999,2002,共4页Chongqing medicine

摘　　要：目的评价厄洛替尼作为挽救方案治疗吉非替尼治疗失败的晚期非小细胞肺癌的疗效及不良反应。方法回顾性分析2005年12月至2009年11月吉非替尼治疗进展后接受厄洛替尼治疗的晚期非小细胞肺癌患者。观察的主要指标为:客观有效率(RR)、疾病控制率(DCR)、疾病无进展生存时间(PFS)、总生存时间(OS)及不良反应。结果随访至2010年6月,共有22例患者符合入组条件。22例患者均可接受疗效及生存评价,其中部分缓解(PR)2例,稳定(SD)12例,进展(PD)8例,RR为9.1%,DCR为63.6%,中位为PFS 3.0个月,OS为5.5个月。4例患者检测了表皮生长因子受体(EGFR)突变,2例有突变,2例无突变,全部患者均得到疾病控制。1例男性吸烟腺癌合并颅内转移患者原发无效给予厄洛替尼治疗后颅内病灶达到CR。亚组分析显示:吉非替尼治疗疗效SD者DCR显著提高(90%vs 58.3%,P=0.031),其RR、PFS及OS分别为20%、3.0个月及5.5个月。Ⅲ/Ⅳ度不良反应主要是皮疹1/22(4.5%)、肝功能损害1/22(4.5%)及肺间质纤维化1/22(4.5%)。结论吉非替尼治疗失败后的晚期非小细胞肺癌给予厄洛替尼挽救治疗具有较好的临床获益率,其中吉非替尼治疗疗效SD患者显著提高疾病控制率。Objective To evaluate the response rate and adverse effects of erlotinib as a salvage treatment for non-small-cell lung cancer（NSCLC）patients after gefitinib treatment.Methods Patients with advanced/metastasis NSCLC received Erlotinib until disease progression or intolerable toxicity as a salvage treatment after failure of gefitinib from December 2005 to November 2009,Response Rate（RR）,Disease Control Rate（DCR）,Progression-Free Survival（PFS）,Overall-Survival（OS）and side-effects were observed.Results Till June 2009,22 patients were enrolled and all were evaluated for response and toxicity.With a median follow-up of 5.5 months,two cases obtained Partial Response（PR）,12 cases Stable Disease（SD）and eight cases Progression Disease（PD）,resulting in a RR of 9.1% and DCR of 63.6%.Median PFS and OS were 3 months and 5.5 months,respectively.Epidermal Growth Factor Receptor（EGFR）mutational analysis was performed in four evaluable caeses,two of them were without EGFR mutation.All the four patients achieved disease control after erlotinib treatment.A male patient who was a smoker with adenocarcinoma had brain metastases and received CR after Erlotinib treatment.Patients who had SD by prior gefitinib treatment obtained significantly higher DCR（90%vs58.3%,P=0.031）.RR,PFS and OS were 20%,3 months and 5.5months in those patients,respectively.Grade 3 to 4 Toxic effects including pulmonary interstitial fibrosis（1/22）,rash（1/22）and liver dysfunction（1/22）were observed.Conclusion Erlotinib as a salvage treatment might be effective for NSCLC patients after failure of gefitinib treatment.Those who had gained SD from prior gefitinib treatment achieved higher disease control rate.

关 键 词：癌 非小细胞肺 厄洛替尼 吉非替尼 

分 类 号：R734.2[医药卫生—肿瘤]