非小细胞肺癌EGFR-TKI耐药后化疗序贯TKI治疗的效果  

Efficacy of sequential TKI in treating non-small cell lung cancer with acquired EGFR-TKI resistance

作　　者：赵皓[1] 黄纯[1] 居建平[1] 施敏骅[2] 

机构地区：[1]苏州市第三人民医院呼吸病科,江苏省215004 [2]苏州大学附属第二医院呼吸病科

出　　处：《江苏医药》2015年第2期165-167,共3页Jiangsu Medical Journal

摘　　要：目的评价铂类化疗药物联合白蛋白结合型紫杉醇序贯酪氨酸激酶抑制剂(TKI)治疗TKI耐药后进展期非小细胞肺癌(NSCLC)患者的疗效和安全性。方法 21例晚期NSCLC患者均口服吉非替尼250mg/d或厄洛替尼150mg/d,耐药后改换铂类药物联合白蛋白结合型紫杉醇化疗序贯原TKI治疗,直到病情进展或不良反应不能耐受为止。观察临床疗效、不良反应以及疗效与临床特征之间的关系。结果 21例患者耐药后序贯治疗的有效率为14.3%,疾病控制率为66.7%,中位疾病进展时间(TTP)为155d。序贯治疗获益的14例患者TTP较未获益的7例患者增加(200d vs.101d)(P<0.01);与6例野生型患者相比,7例敏感突变患者TTP增加(234dvs.90d)(P<0.05);但二线和三线序贯治疗患者TTP比较无统计学差异(P>0.05)。序贯治疗后主要不良反应为轻度皮疹、腹泻及血液学毒性。结论铂联合白蛋白结合型紫杉醇化疗序贯TKI治疗表皮生长因子受体-TKI获得性耐药后NSCLC近期疗效较好,可作为TKI耐药后患者的选择。Objective To evaluate the efficacy and safety of sequential tyrosine kinase inhibitor（TKI）in the treatment of patients with advanced non-small cell lung cancer（NSCLC）after acquired EGFR-TKI resistance.Methods Twenty-one patients with advanced NSCLC were treated with oral gefitinib 250mg/d or erlotinib 150mg/d.After acquired TKI resistance took place,the patients were received subsequent chemotherapy with a nab-paclitaxel/platinum combination regimen until disease progression or intolerable toxicity.The clinical efficacy,adverse reactions and relationship between efficacy and clinical characteristics were observed.Results The effectiveness rate,disease control rate and median time to progression（TTP）of sequential therapy after TKI resistance in 21 patients were14.3%,66.7%and 155 d,respectively.The median TTP of fourteen patients benefited from sequential therapy was longer than that of seven patients without benefit（200dvs.101d）（P〈0.01）.Compared with six patients with wild-type EGFR,the median TTP of seven patients with sensitive EGFR mutation was increased（234dvs.90d）（P〈0.05）.However,there was no significant difference in TTP between the patients treated with second-and third-line sequential therapy（P〉0.05）.The main adverse reactions were mild skin rash,diarrhea and hematologic toxicity.Conclusion Sequential therapy of TKI and chemotherapy with a nab-paclitaxel/platinum combination regimen seems to be effective in the patients with advanced NSCLC after acquired EGFR-TKI resistance.

关 键 词：非小细胞肺癌 表皮生长因子受体-酪氨酸激酶抑制剂 获得性耐药 

分 类 号：R734[医药卫生—肿瘤]