Iressa对一线治疗失败的非小细胞肺癌疗效评估分析

THE CURATIVE EFFECT EVALUATION OF LRESSA ON FAILED TREATMENT OF LUNG CANCER BY FIRST-LINE DRUGS

目的：评价易瑞沙（Iressa）用于一线治疗失败的非小细胞肺癌（NSCLC）,相对于二线化疗及C IK过继免疫治疗,其疗效、肿瘤相关标志物含量变化及不良反应发生情况。方法：将我科2006年2月-2009年3月期间,103例一线治疗失败的NSCLC纳入研究组,根据自身情况及意愿分为三组：Iressa组（应用Iressa250mg/d po,直至肿瘤进展或其他原因停止用药）;化疗组（方案TAX＋DDP、GEM＋DDP、CPT-11＋DDP、NVB＋DDP）;C IK过继免疫治疗组。结果：二线化疗组疗效最佳,其ORR（31.0%）、DCR（64.3%）,但不良反应相对较多且较重,以恶心呕吐、转氨酶升高及白细胞减少为甚。Iressa组其ORR（25.0%）、DCR（62.5%）仅次于二线化疗组,且相关肿瘤标志物CEA、NSE、CA125在治疗前后均有显著差异,不良反应相对二线化疗组明显减少,但皮疹及腹泻发生率高于二线化疗组。C IK过继免疫治疗组其ORR及DCR均最低,相关肿瘤标志物CA125、CA15-3在治疗前后无显著差异,但不良反应发生率最低,无Ⅳ级不良反应发生。结论：Iressa对于不愿或不能耐受化疗的晚期NSCLC,疗效低于二线化疗高于C IK过继免疫治疗,其不良反应相对二线化疗明显减少,但相对于C IK过继免疫治疗具有皮疹及腹泻等明显不良反应,在长期维持治疗中的地位值得深入研究。

OBJECTIVE： To evaluate curative effect of Iressa on failed treatment of non - small cell lung cancer （NSCLC） by first - line drugs. METHOD ： 103 patients hospitalized in our hospital from February 2006 to March 2009 had been failed by first -line drugs treatment. The patients were divided into three groups： Iressa group： Iressa 250mg was administered per day orally till progression of tumor or other reasons ; chemotherapy group ： patients were treated by program of TAX ＋ DDP, GEM ＋ DDP, CPT - 11 ＋ DDP. NVB ＋ DDP ; and the CIK adoptive immunity treatment group. RESULTS ： The second - hne chemotherapy group received best results with ORR 31.0% and DCR 62. 3%, but adverse reactions were severe, such as vomiting, nausea, transaminase elevation and leucopenia. Iressa group （ ORR 25.0%, DCR62.5% ） was next to second - line chemotherapy group in therapeutic results and related tumor markers （CEA, NSE and CA125） presented significandy difference before and after treatment. Adverse reactions reduced in comparison to second - line group but incidence of rashes and diarrhea were higher than second - llne chemotherapy group. CIK group had a lowest ORR and DCR. Its tumor markers CA125, CA15 -3 had no much difference before and after treatment. Adverse reactions rate was the lowest and without IV grade adverse reaction presented. CONCLUSION ： For advanced NSCLC patients intolerant or unwilling to chemotherapy, Iressa is a choice with lower theurapeutic effect rate than second - line drugs and better results than CIK adoptive immunity therapy, but higher incidence of rashes and diarrhea than CIK. Its role in the lone - term maintenance treatment needs further study.