TKI联合替吉奥化疗序贯治疗非小细胞肺癌患者EGFR-TKI获得性耐药的疗效观察

doi:10.3969/j.issn.1006-6233.2018.10.034

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摘要 目的: 探究酪氨酸激酶抑制剂(TKI)联合替吉奥化疗序贯治疗EGFR-TKI获得性耐药非小细胞肺癌的临床疗效。方法: 选取NSCLC、EGFR基因突变的64例患者作为研究对象,根据治疗方式的不同分为对照组与研究组,每组32例,对照组患者单纯采用替吉奥联合顺铂化疗,研究组在对照组基础上联合使用TKI治疗,对比两组患者肿瘤缓解率,治疗前后血清肿瘤标志物癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA211)、糖类抗原199(CA199)水平,统计不良反应发生类型,采用Kaplan-Meier生存分析对1年内患者无生存进展期(PFS)进行分析。结果:研究组肿瘤缓解率高于对照组,差异有统计学意义(75.00%VS46.88% P<0.05)。治疗后两组患者血清中CEA、CYFRA211、NSE水平均降低,研究组降低程度高于对照组(P<0.05)。两组患者治疗后主要出现腹泻、恶心呕吐、肌痛、脱发、发热、乏力、贫血、血小板减少粒细胞减少、转氨酶异常,两组不良反应发生率对比,差异无统计学意义(P>0.05)。研究组PFS高于对照组,两组PFS对比差异有统计学意义(6.83±1.62 VS 8.71±1.85,P<0.05)。结论:对于NSCLC、EGFR基因突变的患者,发生EGFR-TKI获得性耐药后采用TKI联合替吉奥化疗序贯治疗能够延缓病情进展延长患者生存时间,且不良反应有所缓解,是有效的治疗方式。

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	张景杰
	马建新
	王沐
	高文广

关键词 ：非小细胞肺癌, 表皮生长因子受体酪氨酸激酶抑制剂, 获得性耐药, 替吉奥

Abstract：Objective: To explore clinical effect of tyrosine kinase inhibitor (TKI) combined with S-1 chemotherapy in treatment of EGFR-TKI acquired resistance to patients with non-small cell lung cancer. Methods: 64 cases of patients with mutations in NSCLC and EGFR genes treated in our hospital were selected as the study objects, and were divided into control group and the study group according to different treatment methods, 32 cases in each group. Control group were given S-1 combined with cisplatin chemotherapy. the study group were combined with TKI treatment on the basis of control group. Tumor remission rate and serum tumor markers, carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA211), and carbohydrate antigen (CA199) levels before and after treatment were contrasted in the two groups. Types of adverse reactions were reported, and patients without progression of survival (PFS) within 1 years were analyzed by using Kaplan-Meier survival analysis. Results: The tumor remission rate in the study group was higher than that in the control group, and the difference was statistically significant.(75.00%VS46.88% P＜0.05). After treatment, serum CEA, CYFRA211 and CA199 levels decreased in the two groups, and the decreasing in the study group was higher than that in control group (P<0.05). Diarrhea, nausea, vomiting, myalgia, hair loss, fever, fatigue, anemia, thrombocytopenia, granulocyte reduction, and transaminase abnormalities occurred in the two groups after treatment. There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).The PFS of the study group was higher than that of the control group, and the difference between the two groups was statistically significant.(6.83±1.62VS 8.71±1.85 P＜0.05). Conclusion: Patients with mutations in NSCLC and EGFR genes treated by TKI combined with S-1 chemotherapy after EGFR-TKI acquired resistance, it can delay the progression of the disease and prolong patients' survival time, with mild adverse reactions. It is a highly effective treatment.

Key words： Non small cell lung cancer Epidermal growth factor receptor tyrosine kinase inhibitor Acquired resistance S-1

基金资助:河北省2016年度医学科学研究重点课题计划项目,(编号:20160764)

引用本文:

张景杰,马建新,王沐,高文广. TKI联合替吉奥化疗序贯治疗非小细胞肺癌患者EGFR-TKI获得性耐药的疗效观察[J]. 河北医学, 2018, 24(10): 1722-1726.
ZHANG Jingjie, MA Jianxin, WANG Mu, et al. Observation on Curative Effect of TKI Combined with S-1 Chemotherapy in Treatment of EGFR-TKI Acquired Resistance to Patients with Non-small Cell Lung Cancer. HeBei Med, 2018, 24(10): 1722-1726.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2018.10.034 或 http://www.hbyxzzs.cn/CN/Y2018/V24/I10/1722

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