表皮生长因子受体抑制剂gefitinib对改善晚期非小细胞肺癌患者生活质量的作用

The role of epidermal growth factor receptor inhibitor, gefitinib, in improvement of quality of life of patients with non-small cell lung cancer

背景与目的生活质量是评价非小细胞肺癌治疗方法的重要指标.本研究的目的是观察表皮生长因子受体抑制剂gefitinib对晚期非小细胞肺癌患者生活质量的影响.方法对gefitinib慈善用药计划中31例晚期非小细胞肺癌患者进行研究.患者每日口服gefitinib 250 mg,直至病情进展或出现严重的副反应.采用中文版EORTC QLQ-C30和QLQ-LC13问卷对治疗前后症状和生活质量的改变进行评价.结果25例接受gefitinib治疗的患者完成问卷.和治疗前相比,治疗8周后,患者4种功能状态(体格、角色、情感、社会)和整体生活质量评分的均值显著增加,全身症状(乏力和食欲不振)以及疾病相关症状(呼吸困难、咳嗽、胸痛、手臂和肩膀疼痛、身体其他部位疼痛)评分的均值显著降低.治疗后5种功能状态和整体生活质量的有效率均超过50%.主要的全身症状和疾病相关症状的有效率也达到44%～84%.症状和生活质量的改善与临床客观疗效相一致.结论gefitinib对于常规治疗失败的晚期非小细胞肺癌仍能够改善患者的症状和生活质量.

Background and objective Improvement of quality of life （QoL） is an important endpoint for assessment of treatment of non-small cell lung cancer （NSCLC）. This study is to report the changes of QoL before and during the treatment with epidermal growth factor receptor inhibitor, gefitinib, for patients with advanced NSCLC. Methods Thirty one eligible patients with NSCLC, who participated in gefitinib compassionate-use program, were enrolled in the study. One oral gefitinib tablet （250 mg） was administered every day without interruption unless disease progression or unacceptable toxicity occurred. The impact of treatment on disease-related symptoms and QoL was evaluated with the Chinese versions of European Organization for Research and Treatment of Cancer Quality of Life Questionnaires （EORTC QLQ-C30 and QLQ-LC13）. Results After eight weeks of treatment, the mean scores of four functioning scales （physical, role, emotional and social） and global QoL increased .significantly. Mean scores of main general symptoms （fatigue and appetite loss） and disease-related symptoms （dyspnoea, coughing, pain in chest, pain in arm and shoulder and pain in other parts） decreased .significantly. Response rate of five functioning and global QoL were all more than 50% after gefitinib treatment. Response rate of main general symptoms and disease-related symptoms varied from 44%-84%. QoL and symptom response correlated with objective tumor response. Conclusion Gefitinib treatment can improve the QoI. and symptoms of advanced NSCLC patients who failed to conventional treatments.