靶向药物治疗对表皮生长因子受体基因不同位点突变的非小细胞肺癌患者预后影响  

Impact of targeted drug therapy on the prognosis of non small cell lung cancer patients with different mutations in the epidermal growth factor receptor gene

作　　者：姜忠于 胡春秀[1] 刘学武[1] 王立[1] 缪倩[1] 

机构地区：[1]浙江衢化医院肿瘤综合治疗中心,浙江衢州324004

出　　处：《中国临床药理学杂志》2015年第23期2306-2308,共3页The Chinese Journal of Clinical Pharmacology

基　　金：衢州市科技局科技基金资助项目(20111092)

摘　　要：目的对晚期非小细胞肺癌（NSCLC）患者经靶向药物酪氨酸激酶抑制剂（EGFR-TKI）治疗,考察表皮生长因子受体（EGFR）基因不同位点突变患者的预后情况。方法入选69例Ⅲb~Ⅳ期NSCLC患者,按EGFR突变基因情况分为EGFR基因突变型21例（试验组）和EGFR基因野生型48例（对照组）。试验组按基因突变位点不同又分为3组：外显子19突变者11例（试验I组）,外显子21突变8例（试验II组）,外显子20突变2例（试验Ⅲ组）。试验组标准化疗＋盐酸厄洛替尼片150 mg,每日1次,直至病情进展;对照组接受标准化疗方案治疗。全部患者均随访1~2年,评估近期疗效指标（有效率、疾病控制率）,考察无进展生存率、1.5年生存率等生存指标。结果治疗后,试验组和对照组有效率分别为85.7%,52.1%;疾病控制率分别为90.5%,64.6%;试验组3个亚组的有效率分别为72.7%,50.0%,0%,差异均有统计学意义（P〈0.05）。随访1.5年时,试验组和对照组无进展生存率分别为28.6%,8.3%;总生存率分别为47.6%,16.7%;试验组3个亚组患者的无进展生存率分别为90.9%,75.0%,50.0%和总生存率分别为100.0%,75.0%,50.0%,差异均有统计学意义（P〈0.05）。试验组外显子19突变者的治疗效果和预后更好。结论 EGFR基因突变的NSCLC患者经EGFR TKI治疗后临床疗效好,但EGFR基因不同位点突变患者的预后有差异性。Objective To investigated the impact of patients with advanced non small cell lung cancer（ NSCLC） treated by the targeted drug tyrosine kinase inhibitor（ EGFR- TKI）,and the prognosis of the patients with different mutations in the epidermal growth factor receptor（ EGFR） gene. Methods A total of 69 cases of stage Ⅲb- Ⅳ NSCLC patients were selected,there were 21 cases of EGFR gene mutation（ ＋）by DNA testing. Among them,there were 11 cases（ 52. 4%） with outside exon 19 mutations（ treatment group I）,8 cases（ 38. 1%） with outside exon 21 mutations（ treatment group Ⅱ）,2 cases（ 9. 5%） with outside exon 20 mutations（ treatment group Ⅲ）. Patients in treatment group were treated with standard regimens and oral TKI（ erlotinib hydrochloride,150 mg,once daily）. The patients in control group were only treated with standard treatment. All patients were followed up for 1 to 2 years,and the short- term efficacy and disease control rate were evaluated,and the progression- free survival rate and 1. 5 year survival rate were investigated. Results After treatment,effective rate of treatment and control group（ 85. 7%,52. 1%） and disease control rate（ 90. 5%,64. 6%） had significant difference（ P〈0. 05）; the difference of effective rate in three sub groups of treatment group also had statistically significance（ 72. 7%,50. 0%,0%,P〈0. 05）. At follow- up of 1. 5 years,the progression- free survival rate（ 28. 6% and 8. 3%） and total survival rate（ 47. 6%,16. 7%） of treatment and control groups were significant difference,the significant differences were also observed in the three sub- groups in treatment group（ P〈0. 05）. The treatment effect and the prognosis of patients with the exon 19 mutations in treatment group Ⅰ were better.Conclusion Good clinical effect of NSCLC patients with EGFR gene mutations was obtained by the treatment of TKI,but the prognosis of patients with different mutations of EGFR gene was different.

关 键 词：靶向治疗 非小细胞肺癌 酪氨酸激酶抑制剂 

分 类 号：R734.2[医药卫生—肿瘤] R979.1[医药卫生—临床医学]