晚期非小细胞肺癌患者表皮生长因子受体基因状态与酪氨酸激酶抑制剂一线治疗效果的关系  

Relation between the gene status of epidermal growth factor receptor and efficacy of the first-line tyrosine kinase inhibitor in patients with advanced non-small cell lung cancer

作　　者：姜海英[1] 朱梅[1] 李艳芳[1] 李倩[1] 吕姣[1] 李静[1] 

机构地区：[1]徐州市肿瘤医院肿瘤内科,221005

出　　处：《肿瘤研究与临床》2016年第6期373-377,共5页Cancer Research and Clinic

基　　金：“十二五”国家科技支撑计划（2013BAI06B04H008）

摘　　要：目的分析不同表皮生长因子受体（EGFR）突变状态与表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）一线治疗晚期非小细胞肺癌（NSCLC）疗效的关系。方法收集徐州市肿瘤医院2008年1月至2013年12月经组织病理学证实的门诊及住院EGFR（外显子19、21）突变的Ⅲ。或Ⅳ期NSCLC患者72例，分析EGFR突变状态与一线EGFR-TKI疗效、无进展生存（PFS）间的关系。结果72例患者均进行过EGFR基因检测，其中EGFR外显子19缺失37例，EGFR外显子21突变35例。72例患者均可评价疗效，其中完全缓解（CR）2例，部分缓解（PR）44例，稳定（SD）11例，进展（PD）15例，客观缓解率（ORR）63．9％（46／72），疾病控制率（DCR）79．2％（57／72）；其中，外显子19缺失患者CR1例，PR27例，SD5例，PD4例，ORR75．7％（28／37），DCR89．2％（33／37）；EGFR外显子21突变患者CR1例，PR17例，SD6例，PD11例，ORR51．4％（18／35），DCR68．6％（24／35）；两种不同EGFR突变状态患者ORR及DCR差异均有统计学意义（P=0．032，P=0．031）。EGFR外显子19缺失的患者中位PFS为12．0个月，EGFR外显子21突变的患者为9．5个月（P=0．030）。Cox多因素分析显示性别、病理类型、吸烟为影响PFS的主要因素。两组间不良反应发生率差异无统计学意义（P〉0．05）。结论EGFR突变状态是一线EGFR-TKI治疗晚期NSCLC患者PFS和ORR的预测因素。Objective To explore the relationship between mutation status of epidermal growth factor receptor （EGFR） and efficacy of EGFR tyrosine kinase inhibitor （EGFR-TKI） in patients with advanced non- small cell lung cancer （NSCLC）. Methods The data of 72 outpatients and inpatients with stage Ⅲ b/Ⅳ NSCLC diagnosed by histopathology and harbored EGFR-activating mutations （exon 19 and exon 21） from January 2008 to December 2013 in Xuzhou Cancer Hospital were collected. All of them received first-line EGFR-TKI. The relationships between EGFR gene status and response rate or progression-free survival （PFS） were analyzed. Results Of the 72 patients with EGFR mutation, 37 patients harbored exon 19 deletion, and 35 patients harbored exon 21 L858R point mutation. The efficacies of all patients were assessable. The objective response rate （ORR） was 63.9 % （46/72） and disease control rate （DCR） was 79.2 % （57/72） in all patients, including 2 cases of complete remission （CR）, 44 cases of partial remission （PR）, 11 cases stable disease （SD） and 15 cases of disease progression （PD）. Patients with exon 19 deletion had a higher ORR [75.7 % （28/37） vs 51.4 % （18/35）, P = 0.032] and a higher DCR [89.2 % （33/37） vs 68.6 % （24/35）, P = 0.031] than patients with exon 21 L858R mutation. The PFS of patients with exon 19 deletion was significantly longer than that of patients with exon 21 L858R mutation （12.0 months vs 9.5 months, P = 0.030）. Cox multivariate analysis indicated that the gender, histological type, smoking history were the major influence factors of PFS. The differences of toxicity between the two groups were not significant. Conclusion EGFR-activating mutation is a predictor for PFS and ORR of first-line EGFR-TKI in patients with advanced NSCLC.

关 键 词：癌 非小细胞肺 受体 表皮生长因子 酪氨酸激酶抑制剂 

分 类 号：R734.2[医药卫生—肿瘤]