益气养阴解毒抗突变复方延缓EGFR敏感突变型肺癌吉非替尼获得性耐药的研究  

The Yi Qi Yang Yin Jie Du Anti-mutagenic Compound Recipe Delay of Gefitinib Acquired Drug Resistance of Lung Cancer with EGFR Sensitive Mutation

作　　者：马进安[1] 胡春宏[1] 伍参荣[2] 何明大[1] 张四方[1] 邹文[1] 谢贵元[1] 马芳[1] 张海霞[1] 王晶晶[1] 

机构地区：[1]中南大学湘雅二医院,湖南长沙410011 [2]湖南中医药大学,湖南长沙410208

出　　处：《中医药导报》2015年第7期31-35,共5页Guiding Journal of Traditional Chinese Medicine and Pharmacy

摘　　要：目的:鉴定益气养阴解毒抗突变复方的抗突变功效,回顾性分析该方同步配合表皮生长因子受体酪氨酸激酶抑制剂吉非替尼治疗表皮生长因子受体(epidermal growth factor receptor,EGFR)敏感突变型肺癌的疗效,及其对毒副作用的影响。方法:采用Ames试验对益气养阴解毒抗突变复方水提液进行抗突变功效检测。2010年5月至2014年10月共有56例具有EGFR敏感突变的IV期肺癌患者采用益气养阴解毒抗突变复方配合吉非替尼进行治疗,每2月CT评价1次疗效,并评估患者毒副作用。结果:Ames试验显示不同浓度的益气养阴解毒抗突变复方水提液,均能明显抑制直接诱变剂敌克松,间接诱变剂叠氮钠和2-氨基芴诱导的组氨酸营养缺陷型鼠伤寒沙门氏菌株TA97、TA98、TA100、TA102的回复性突变,并具备一定的量效关系。益气养阴解毒抗突变复方配合吉非替尼治疗EGFR敏感突变型肺癌的中位无进展生存期为12.3月,未见III度以上毒副作用。结论:益气养阴解毒抗突变复方具有良好的抗突变作用,配合吉非替尼治疗EGFR敏感突变型肺癌能延长无进展生存时间,并减轻毒副作用。该方能延缓吉非替尼获得性耐药的出现,但抗突变功效是否为其主要作用机制值得进一步研究。Objective： To observe the anti-mutation effect of the Yiqiyangyinjiedu anti-mutagenic compound recipe（益气养阴解毒抗突变复方） and analyse the curative effect and side effect of it synchronized with the epidermal growth factor receptor ty- rosine kinase inhibitor gefitinib on the sensitive mutant EGFR of lung cancer, retrospectively. Methods： The Ames experiment was used to test anti-mutation effect of Yiqiyangyiniiedu anti-mutagenic compound decoction. From May, 2010 to October, 2014, totally 56 cases of patients with stage IV and EGFR sensitive mutant lung cancer treated with Yiqiyangyiniiedu anti-mutagenic compound recipe synchronized with the gefitinib. The afficacy was evaluated by CT every two months and side effects were also estimated. Results： The Ames experiment showed that different concentrations of Yiqiyangyiniiedu anti-mutagenic compound recipe could significantly inhibited the direct mutagen Dexon, indirect mutagen sodium azide and 2-aminofluorene induced histi- dine auxotroph Salmonella typhimurium strains TA97, TA98, TA100,TA102 back to the mutation, and had a certain amount of activity relationship.The combination of this compound recipe and gefitinib treated on the EGFR sensitive mutant lung cancer patients showed the median progression free survival of them was 12.3 months, without the side effects above Ⅲ degree. Conclusion： Yiqiyangyiniiedu anti-mutagenic compound recipe has good anti-mutation effect, and jointed with gefitinib treatment of EGFR sensitive mutant lung cancer can prolong progression free survival time, and reduce side effects. This compound recipe can delay of gefitinib in the emergence of acquired drug resistance, but it is worthy of further study if the anti-mutation effect is the main mechanism.

关 键 词：益气养阴解毒抗突变复方 肺癌 EGFR 吉非替尼 获得性耐药 

分 类 号：R273[医药卫生—中西医结合]