吉非替尼新辅助治疗ⅢA-N2期表皮生长因子敏感突变肺癌的临床观察  

Clinical observation of neoadjuvant gefitinib treatment for stage ⅢA-N2 lung cancer in the patients with sensitive EGFR mutations

作　　者：许有涛[1] 尹荣[1] 李明[1] 杨欣[1] 张治[1] 蒋峰[1] 王洁[1] 许林[1] 

机构地区：[1]南京医科大学附属肿瘤医院胸外科,江苏省恶性肿瘤分子生物学及转化医学重点实验室,江苏省肿瘤防治研究所

出　　处：《实用老年医学》2014年第6期469-472,共4页Practical Geriatrics

基　　金：江苏省卫生厅面上项目(H201064);江苏省"六大人才高峰"项目(WS-116;10-D-078);江苏省自然科学重点研究专项(BK2011036);江苏省临床医学科技专项(BL2012030)

摘　　要：目的观察吉非替尼新辅助治疗ⅢA-N2期表皮生长因子受体(EGFR)敏感突变肺癌患者的临床效果,并评价其安全性和可行性。方法在72例经PET-CT或超声支气管镜穿刺活检证实ⅢA-N2期肺癌患者中筛选出具有EGFR敏感位点突变的可手术患者共6例,接受吉非替尼(250 mg/d)新辅助治疗1月后进行手术治疗,术后继续口服吉非替尼维持治疗直至病情进展或耐药,坚持长期随访。结果 6例患者中位随访时间24月,中位无进展生存期17月,中位生存期24月。6例患者接受吉非替尼新辅助治疗后未出现严重的毒性反应,亦未给外科手术及围手术期处理带来不利。6例患者中5例纵隔转移性淋巴结获得了客观缓解,3例患者原发灶获得客观缓解。术后病理分期证实其中4例患者新辅助治疗后获得了TNM降期。结论吉非替尼新辅助治疗未发现围手术期严重不良事件,可降低EGFR敏感突变肺癌患者的术前分期,值得进一步在具有EGFR敏感突变的ⅢA-N2肺癌人群中开展大样本研究。Objective To observe the clinical effects of neoadjuvant gefitinib treatment for stage ⅢA-N2 lung cancer in the patients with sensitive EGFR mutations and to evaluate the safety and feasibility. Methods Out of 72 patients with non-small-cell lung cancer （NSCLC） at stage ⅢA-N2, 6 patients with sensitive EGFR mutations were enrolled in the present study. The N2 postitive lymph nodes were diagnosed by PET-CT or ultrasound bronchoscopy biopsy. These patients received gefitinib 250 mg/d for up to a month followed by surgical resection, and then receiving gefitinib maintenance treatment until disease progression or drug resistance during long term follow-up. Results The median follow-up time of six cases was 24 months, the median progression-free survival time was 17 months, and the median survival time was 24 months. Postoperative pathological re-staging confirmed that after neoadjuvant therapy, four patients＇ TNM stage decreased. Neoadjuvant gefitinib therapy didn＇t induce severe toxities or any serious impairments to the surgical resection and perioperative management. Of all six patients, five cases obtained objective response （OR） of metastatic mediastinal lymph nodes and three gained OR of the primary tumors. Conclusions Neoadjuvant gefitinib treatment can reduc the preoperative stage of sensitive EGFR mutation NSCLC in the patients without serious perioperative adverse events.

关 键 词：吉非替尼 肺癌 新辅助治疗 表皮生长因子受体突变 

分 类 号：R734.2[医药卫生—肿瘤]