非小细胞肺癌一代EGFR-TKI耐药后使用三代EGFR-TKI的患者随访及治疗总结  

Follow-up of NSCLC patients with first-generation EGFR-TKI resistance using third-generation EGFR-TKI

作　　者：黄渊锋 赵健 孙梅辉 曾祥 谢巧梅 彭聪 Huang Yuanfeng;Zhao Jian;Sun Meihui;Zeng Xiang;Xie Qiaomei;Peng Cong(Department of Thoracic Surgery,the Affiliated Cancer Hospital of Guangzhou Medical University,Guangzhou 510095,China;Department of Abdominal Oncology Surgery,the Affiliated Cancer Hospital of Guangzhou Medical University,Guangzhou 510095,China;Department of Pathology,the Affiliated Cancer Hospital of Guangzhou Medical University^Guangzhou 510095,China)

机构地区：[1]广州医科大学附属肿瘤医院胸外科,510095 [2]广州医科大学附属肿瘤医院腹部肿瘤外科,510095 [3]广州医科大学附属肿瘤医院病理科,510095

出　　处：《中国医师杂志》2020年第5期656-661,共6页Journal of Chinese Physician

摘　　要：目的分析一代表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)耐药后使用三代EGFR-TKI对晚期非小细胞肺癌(NSCLC)患者的临床疗效。方法收集2015年1月至2020年3月在广州医科大学附属肿瘤医院就诊的晚期(ⅢB~Ⅳ期)NSCLC患者的临床资料,从中筛选出23例一代EGFR-TKI耐药后服用三代EGFR-TKI药物的患者,作中期随访,分析其临床病理特征,研究其治疗效果,分析一代EGFR-TKI耐药后使用三代EGFR-TKI的晚期NSCLC患者治疗情况和预后。结果在23例晚期NSCLC患者中,服用一代EGFR-TKI后发生局部进展的有16例(69.57%),全身进展7例(31.43%)。其中位无进展生存时间(PFS)为17.5个月。服用一代EGFR-TKI后出现皮疹的共有7例,肝功能异常者共3例,予以对症治疗后均好转。三代EGFR-TKI治疗未见明显皮疹、肝功能异常,无骨髓抑制(粒细胞、中性粒细胞减少、血小板减少、贫血)和消化道反应(恶心、呕吐、腹泻)。19例患者自诉服用三代EGFR-TKI精神、体力较一代EGFR-TKI治疗改善更加明显;其中15例对比一代EGFR-TKI治疗后,病灶缩小更明显;4例具有毛玻璃样结节病灶较一代EGFR-TKI治疗消失更加干净。结论与传统化疗相比,一代EGFR-TKI耐药后使用三代EGFR-TKI治疗的方案疗效较好、毒副反应较少。Objective To analyze the clinical efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs)in patients with advanced NSCLC.Methods We collected 23 cases of NSCLC advanced patients,who were treated in the affiliated Cancer Hospital of Guangzhou Medical University from January 2015 to March 2020.And these 23 cases of patients with first-generation EGFR-TKIs resistance were treated with the third-generation EGFR-TKI drugs.We analyzed their clinicopathological characteristics,studied their therapeutic effects,and followed up their progression-free survival(PFS).Results It is showed that 16 of 23 cases(69.56%)were got local progression and 7 of 23 cases(31.43%)were found with systemic progression.Briefly,the median PFS of the 23 patients was 17.5 months.A total of 7 cases occurred rashes after taking EGFR-TKI,and 3 cases got abnormal liver function.Fortunately,they were all improved after symptomatic treatments.Additionally,no bone marrow suppression(granulocytes,neutropenia,thrombocytopenia,anemia)and digestive tract reactions(nausea,vomiting,diarrhea)were occurred in 23 cases of NSCLC patients.The mental and physical improvement of EGFR-TKI in the third generation of 19 patients was more obvious than that in the first generation of EGFR-TKI.Among them,15 cases showed more obvious lesion shrinkage after third-generation EGFR-TKI treatment.4 patients with GGO had cleaner disappearance than that of the first-generation EGFR-TKI.Conclusions Compared with traditional chemotherapy,the first-generation EGFR-TKI resistance treatment with three-generation EGFR-TKI treatment has better efficacy with reduced toxic and side effects,and significantly improved the life quality of advanced NSCLC patients.

关 键 词：癌 非小细胞肺 受体 表皮生长因子 突变 蛋白激酶抑制剂 分子靶向治疗 抗药性 

分 类 号：R734.2[医药卫生—肿瘤]