第一代抗表皮生长因子受体靶向药物对驱动基因阳性非小细胞肺癌的临床疗效  

First-generation anti-EGFR targeted drugs in driver gene positive non-small cell lung cancer

作　　者：高金锁 王建冰 刘玮玮 GAO Jin-suo;WANG Jian-bing;LIU Wei-wei(Department of Oncology and Hematology,the Third People’s Hospital of Hefei,Hefei,Anhui 230022,China)

机构地区：[1]安徽省合肥市第三人民医院肿瘤血液科,安徽合肥230022

出　　处：《中国临床研究》2021年第3期309-313,318,共6页Chinese Journal of Clinical Research

基　　金：安徽省自然科学基金(1708085MH162)。

摘　　要：目的探讨第一代抗表皮生长因子受体(EGFR)靶向药物对驱动基因阳性的非小细胞肺癌(NSCLC)临床疗效及对癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片段(CY211)的影响。方法选取2017年1月至2019年4月合肥市第三人民医院112例驱动基因阳性的NSCLC患者,采用随机数字表法分为4组,各28例。4组均给予吉西他滨联合顺铂化疗,于此基础上,埃克替尼组采取埃克替尼,国产吉非替尼组采取国产吉非替尼,进口吉非替尼组采取进口吉非替尼,厄洛替尼组采取厄洛替尼。治疗3个月后,比较4组治疗总有效率、疾病控制率、不良反应发生情况、血清CEA、NSE、CY211、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、促血管生成素2(Ang-2)水平;随访12个月,统计4组生存率及无进展生存期。结果治疗3个月评价,4组治疗总有效率、疾病控制率比较,差异无统计学意义(P>0.05);4组治疗3个月后血清CEA、NSE、CY211水平和血清VEGF、bFGF、Ang-2水平均低于治疗前(P<0.05);4组Ⅰ~Ⅱ级皮疹发生率差异有统计学意义,以厄洛替尼组为高(P<0.05),4组其他不良反应发生率对比,差异无统计学意义(P>0.05);随访12个月,埃克替尼组、国产吉非替尼组、进口吉非替尼组和尼洛替尼组完成随访患者的生存率(77.78%、67.86%、74.07%、69.23%)、无进展生存期对比,差异无统计学意义(P>0.05);4组治疗方案成本-效果分析比较,差异无统计学意义(P>0.05)。结论采用第一代抗EGFR靶向药物治疗驱动基因阳性的NSCLC患者,均能取得良好疗效,显著下调患者血清CEA、NSE、CY211水平,有效抑制新血管生成,提高患者1年生存率,延长无进展生存期,其中采用厄洛替尼治疗的成本-效果较好,但存在皮疹发生率高的不足,可根据患者实际情况选取合适药物。Objective To explore the effects of the first generation of anti-epidermal growth factor receptor(EGFR)targeted drugs on the clinical efficacy of driver gene-positive non-small cell lung cancer(NSCLC)and on carcinoembryonic antigen(CEA),neuron-specific enolase(NSE),and cytokeratin 19 fragment(CY211).Methods From January 2017 to April 2019,112 patients with driver gene-positive NSCLC were treated and randomly divided into 4 groups(n=28,each).Based on gemcitabine combined with cisplatin chemotherapy performed in four groups,icotinib,domestic gefitinib,imported gefitinib and erlotinib were respectively given in icotinib group,domestic gefitinib group,imported gefitinib group and erlotinib group.After 3 months of treatment,the total efficiency,disease control rate,incidence of adverse reactions,serum levels of CEA,NSE,CY211,vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF)and angiopoietin 2(Ang-2)were compared among 4 groups.All patients were followed up for 12 months,and the survival rate and progression-free survival were recorded.Results Three months after treatment,there were no significant differences in the total efficiency and disease control rate among four groups(P>0.05).Compared with those before treatment,the levels of CEA,NSE,CY211,VEGF,bFGF and Ang-2 decreased significantly after treatment in 4 groups(P<0.05).There was significant difference in the incidence of gradeⅠ-Ⅱrash among four groups,with the highest in erlotinib group(P<0.05),but there was no significant difference in the incidence of other adverse reactions among 4 groups(P>0.05).After 12 months of follow-up,the survival rates were respectively 77.78%in icotinib group,67.86%in domestic gefitinib group,74.07%in imported gefitinib group and 69.23%in erlotinib group(P>0.05).There were no significant differences in progression free survival and in cost-effectiveness analysis among four groups(all P>0.05).Conclusion In the treatment of NSCLC patients with positive driver genes,the first generation of anti-EGFR targete

关 键 词：非小细胞肺癌 驱动基因阳性 第一代抗EGFR靶向药物 癌胚抗原 神经元特异性烯醇化酶 细胞角蛋白19片段 

分 类 号：R734.2[医药卫生—肿瘤]