易瑞沙在晚期非小细胞肺癌化疗失败后的作用

IRESSA in the treatment of advanced non-small-cell lung cancer patients who failed to respord previous chemotherapy

目的探讨选择性表皮生长因子受体酪氨酸激酶抑制剂易瑞沙(IRESSA)单药治疗化疗失败的晚期非小细胞肺癌(NSCLC)的疗效及不良反应。方法既往化疗失败的Ⅳ期NSCLC患者52例,其中二线治疗失败者占77.0%。IRESSA250mg,口服,每日1次,服用至病情进展或出现不可耐受不良反应。患者分别在治疗后1个月、3个月及以后每2个月复查。结果本组52例均可评价疗效,其中PR11例,NC17例,PD24例,有效率21.2%,稳定率32.7%,疾病控制率(PR+NC)为53.8%,无CR。中位肿瘤进展时间(TTP)为3.5个月。随诊>12个月的患者22例,1年生存率为31.8%,肿瘤相关症状缓解率为52.9%。常见不良反应为Ⅰ、Ⅱ度皮肤改变和腹泻,Ⅲ度不良反应占7.6%,其中1例因转氨酶升高结束治疗。结论IRESSA单药对化疗失败的晚期NSCLC疗效明确,并可用于一般状况评分较差的患者,不良反应较轻,是二、三线用药的良好选择。

Objective To evaluate the antitumor efficacy, time to tumor progression (TTP) and toxicity of Iressa(ZD1839)-a selective epidermal growth factor receptor tyrosine kinase inhibitor in advanced non-small-cell lung cancer (NSCLC) patients who have failed to respord previous chemotherapy. Methods Fifty-two patients with grade Ⅳ NSCLC previously treated with chemotherapy (77.0% of patients after second line therapy) received 250 mg of Iressa orally once daily until disease progression or development of intolerable toxic reaction. They were required to receive tumor-evaluation before the treatment, one month after Iressa administration and every other month thereafter. Results Without complete regression being observed, partial response(PR) rate was 21.2% (11/52), stable disease (SD) 32.7% (17/52),disease control rate (PR+SD) 53.8%,progression of disease(PD) 46.2%(24/52); median time to tumor progression(TTP) was 3.5 month. Among them, 22 patients were followed up over one year and the 1-year survival rate was 31.8%. Symptomatic improvement rate was 52.9%. The most common adverse effects were skin reactions and diarrhea which were generally mild (grade 1 or 2). Only one patient withdrew from the trial because of grade Ⅲ hepatic toxicity with increase in ALT and AST. Conclusion Iressa has significant antitumor activity in advanced NSCLC patients who have previously failed in second or third line chemotherapy. It greatly alleviates tumor related symptoms. Adverse effects are generally tolerable. IRESSA is suitable for patients with poor performance status(ECOG>2).