一代EGFR-TKI治疗后缓慢进展的晚期NSCLC患者原药维持联合阿帕替尼的疗效及安全性  

Efficacy and safety of the original drug combined with apatinib in patients with advanced NSCLC who progress slowly after EGFR-TKI treatment

作　　者：于凯伊 戴朝霞[1] Yu Kaiyi;Dai Zhaoxia(Department of Oncology,the Second Hospital of Dalian Medical University,Liaoing Dalian 116000,China)

机构地区：[1]大连医科大学附属第二医院肿瘤三科

出　　处：《现代肿瘤医学》2019年第22期4001-4005,共5页Journal of Modern Oncology

基　　金：吴阶平医学基金会临床科研专项资助基金(编号:320.6750.18103)

摘　　要：目的:观察一代EGFR-TKI治疗后缓慢进展的晚期NSCLC患者继续原药联合阿帕替尼的疗效及安全性。方法:收集2016年9月至2018年7月于大连医科大学附属第二医院肿瘤内科就诊的29例经一代EGFR-TKI单药治疗后缓慢进展(疾病控制≥6个月,与以往评估相比,肿瘤负荷较前轻度增加2分,症状评分1分),继续原药维持联合阿帕替尼(250 mg/日1次)的晚期NSCLC患者的病例资料,观察客观缓解率(ORR)、疾病控制率(DCR)、中位无进展生存期(mPFS)及不良反应情况。结果:29例患者中,ORR为13.8%,DCR为86.2%,mPFS为5.470个月(95%CI 4.367~6.573个月);常见的药物相关毒性反应是高血压、乏力和蛋白尿,经治疗后症状改善;其中4例经联合治疗一段时间后,临床症状稳定,出现病灶增大,但未达到疾病进展的患者,未换其他治疗方案,而是将阿帕替尼的用量加至500 mg/日1次,病灶再次稳定或缩小;L858R突变患者的mPFS比19号外显子缺失者显著延长,差异有统计学意义(P=0.011)。结论:一代EGFR-TKI治疗后缓慢进展的晚期NSCLC患者原药维持联合阿帕替尼治疗有效,且具有可接受可控的毒副作用。Objective: To observe the efficacy and safety of the original drug combined with apatinib in patients with advanced NSCLC who have progressed slowly after EGFR-TKI treatment. Methods: 29 patients with advanced NSCLC in our hospital from September 2016 to July 2018 were collected,who have progressed slowly after the first generation EGFR-TKI treatment(disease control ≥6 months,compared with the previous assessment,the tumor load was slightly increased by ≤2 points,symptom score ≤1 point). And continuing the original drug combined with apatinib to observe the objective response rate(ORR),disease control rate(DCR),and median progression-free survival(PFS),and adverse events. Results: The ORR was 13. 8%,DCR was 86. 2%,and m PFS was 5. 470 months(95% CI4. 367 ~ 6. 573 months). Common drug-related toxicities were hypertension,fatigue,and urinary proteint. The symptoms were improved after treatment. 4 patients who clinical symptoms were stable and increased lesions after a combination of treatment for a period of time,but did not reach the progress of the disease,did not change other treatment options,the dose of apatinib was added to 500 mg/d,the lesions stabilized or reduced again. Among the EGFR-sensitive mutations,the median PFS of the L858 R point mutation patients was significantly longer than that of the 19 th exon non-frameshift patients,and the difference was statistically significant(P = 0. 011). Conclusion: Patients with advanced NSCLC who progress slowly after EGFR-TKI treatment are effective in combination with apatinib and have acceptable and toxic side effects.

关 键 词：非小细胞肺癌 缓慢进展 EGFR-TKI 阿帕替尼 疗效 

分 类 号：R734.2[医药卫生—肿瘤]