肺腺癌EGFR-TKI耐药后继续靶向药联合化疗的临床疗效  

Clinical evaluation of gefitinib or icotinib combination with chemotherapy after first-line EGFR-TKI resistance in advanced lung adenocarcinoma

作　　者：王蓉[1] 郭人花[1] 卢凯华[1] 刘连科[1] 束永前[1] Wang Rong;Guo Renhua;Lu Kaihua;Liu Lianke;Shu Yongqian(Department of Oncology ,the First Affiliated Hospital of NMU,Nanjing ,210029,China)

机构地区：[1]南京医科大学第一附属医院肿瘤科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2018年第12期1701-1705,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金青年科学基金(81502513);江苏省基础研究计划(自然科学基金)青年基金(BK20151028)

摘　　要：目的:探讨表皮生长因子受体(EGFR)突变的晚期肺腺癌一线酪氨酸激酶抑制剂(TKI)治疗耐药后予靶向药联合培美曲塞含铂化疗或单用化疗的临床疗效。方法:经一线EGFR-TKI治疗后获继发性耐药的ⅢB期或Ⅳ期肺腺癌患者50例,联合组采用培美曲塞+卡铂+一线靶向药进行治疗,化疗组单用化疗,观察两组治疗效果、不良反应情况。结果:联合组与化疗组近期疗效疾病控制率和有效率无显著性差异,远期疗效无进展生存期(mPFS)分别为10.4个月和8.9个月,无统计学差异;亚组分析显示,T790M未突变患者m PFS分别为11.1个月和8.3个月,合并脑转移患者mPFS分别为7.6个月和5.7个月,均具有统计学差异(P <0.05),EGFR突变类型及吸烟亚组的近期及远期疗效均无显著性差异;两组不良反应主要是Ⅰ～Ⅱ级骨髓抑制、消化道反应、乏力等,联合组Ⅰ～Ⅱ级皮疹和腹泻明显多于化疗组,差异有统计学意义(P <0.05)。结论:EGFR突变的晚期肺腺癌一线TKI治疗耐药后继续予靶向药联合培美曲塞含铂化疗的方案具有一定的临床推广及应用价值。Objective:To investigate the clinical efficacy of epidermal growth factor receptor(EGFR)mutated tyrosine kinase inhibitor(TKI)combination of pemetrexed and carboplatin versus chemotherapy alone after first-line EGFR-TKI resistance in advanced lung adenocarcinoma. Methods:Fifty patients with stage ⅢB~Ⅳ lung adenocarcinoma that had been treated with EGFR-TKI were divided into two groups:the combined group was treated with pemetrexed+carboplatin+gefitinib or icotinib. the other was chemotherapy alone. The therapeutic effect and side effects of the two groups were observed. Results:There was no significant difference in DCR and ORR between the combined group and chemotherapy group,and the mPFS of the two groups were 10.4 months vs 8.9 months(P >0.05);The mPFS of patients with T790 M-negative were 11.1 months vs 8.3 months,and 7.6 months vs 5.7 months in patients with brain metastasis,which showed a better outcome in combined group(P < 0.05);In the subgroups of smoking and different mutation types of EGFR,there was no significant difference in the curative efficacies between the two treatments. The main side effects of the two groups were myelosuppression、digestive tract reaction and fatigue. Skin rash and diarrhea in grade Ⅰ ~ Ⅱ were significantly higher in combined group(P < 0.05). Conclusion:The combination treatment of continuation first-line EGFR-TKI plus pemetrexed and carboplatin in advanced lung adenocarcinoma has certain clinical promotion and application value.

关 键 词：肺腺癌 EGFR—TKI 培美曲塞 

分 类 号：R734.2[医药卫生—肿瘤]