表皮生长因子受体酪氨酸激酶抑制剂治疗失败后晚期非小细胞肺癌患者的化疗

Analysis of chemotherapeutic efficacy after a failed regimen of epidermal growth factor receptor- tyrosine kinase inhibitor in patients with advanced non-small cell lung carcinoma

目的分析表皮生长因子受体酪氨酸激酶抑制剂（EGFR—TKI）治疗失败后晚期非小细胞肺癌（NSCLC）化疗的疗效。方法回顾性分析2005年1月至2006年12月EGFR—TKI治疗失败后接受化疗的87例晚期NSCLC患者的临床资料，其中男性37例，年龄31～76岁，平均56±11岁；女性50例，年龄31～78岁，平均56±13岁。双药化疗者61例，单药化疗者26例。主要研究终点为总生存期（OS），次要研究终点为有效率（ORR）及不良反应。结果全部患者OS为9．4±6．0（范围2—33）个月，ORR为9．2％（8／87）。双药组OS为9．115．2（范围2～31）个月，ORR为11．5％（7／61）；单药组0s为10．0-4-7．3（范围3～33）个月；ORR为3．8％（1／26）；两组比较差异均无统计学意义（P〉0．05）。化疗常见不良反应主要为骨髓抑制和胃肠道反应，骨髓抑制发生率为87．4％（76／87），其中3／4度骨髓抑制发生率为33．3％（29／87）；胃肠道反应发生率为86．2％（75／87），其中3度胃肠道反应10．3％（9／87）。结论晚期NSCLC患者EGFR—TKI治疗失败后化疗可使OS延长；只要患者能够耐受就应积极给予化疗。

Objective To analyze the treatment efficacy after a failed regimen of epidermal growth factor receptor-tyrosine kinase inhibitor （EGFR-TKI） in patients with advanced non-small cell lung carcinoma （NSCLC）. Methods A retrospective analysis was conducted for 87 patients with advanced NSCLC at our hospital from January of 2005 to December of 2006. All subjects received chemotherapy after a failure of EGFR-TKI, there were 37 cases of male and the median age was 56 ± 11 （range, 31-76）years, 50 cases of female, median age 56 ±13 （range, 31-78 ） years; They received a 2-drug combination chemotherapy （n = 61 ） and a monodrug chemotherapy （n = 26）. The primary endpoint was overall survival （OS）. And the secondary endpoints were objective response rate （ORR） and side effects. Results The OS was 9. 4 ± 6. 0 （ range, 2-33 ） months and ORR 9. 2% （8/87）. The OS was 9. 1 ± 5.2 （ range, 2-31 ） months in combination chemotherapy group and 10. 0±7.3 （range, 3-33） months in monodrug group; the ORRs were 11.5% （ 7/61 ） and 3.8% （ 1/26 ） respectively in two groups. There was no significant difference in OS and ORR between two groups （P 〉 0. 05 ）. The common side effects were myelosuppression and nausea/vomiting. The rate of myelosuppression was 87.4% （76/87） and that of 3/4 grade myelosuppression 33.3% （29/87）. And the rate of nausea/vomiting was 86. 2% （75/87） and that of 3/4 grade nausea/vomiting 10. 3% （9/87）. Other side effects were mild and well-tolerated. Conclusion If tolerated, chemotherapy after an EGFR-TKI failure may prolong the survival in advanced NSCLC patients.