吉非替尼治疗晚期非小细胞肺癌耐药后的进展模式分析

Progressive Patterns of Gifitinib Treating Advanced Non-small Cell Lung Cancer after Obtained Resistance

背景与目的观察表皮生长因子受体酪氨酸激酶抑制剂吉非替尼(Iressa)治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)获益后出现耐药的临床表现和进程。方法回顾性分析了我院内科接受吉非替尼治疗的93例晚期NSCLC患者,有效或稳定超过6个月,腺癌94.6%,女性79.6%,不吸烟者80.6%。每2个月评估疗效,观察耐药出现的临床表现。结果本组93例,中位服药时间16个月(8个月-70个月),用药时间超过2年占21.5%(20/93),超过3年8.6%(8/93)。耐药出现时的临床表现主要为胸腔内进展,占80%(72/90),其中原发病灶及术后断端复发进展占38.9%(35/90),肺内转移占51.1%(46/90),胸膜转移占25.6%(23/90);颅内进展30%(30/90);腹腔内进展15.6%(14/90)。结论 EGFRTKI治疗耐药后的进展在临床上表现为多样化,治疗后的预后不同,因此,需要密切的临床随访以期早期发现、及时处理。

Background and objective Clinical observation was conducted on the resistance to epidermal growth factor receptor tyrosine kinase inhibitor （EGFR-TKI） gefitinib （Iressa） therapy for advanced non-small cell lung cancer （NSCLC） patients. Methods Ninety-three NSCLC patients in our hospital, showing effective or stable condition after 6-month previous gefitinib therapy, were included in this investigation. Among the patients, 94.6%of them were suffering from adenocarcinoma. hTe percentage of female is 79.6%;the percentage of non-smoking is 80.6%. During the therapy period, follow-up was preformed every 2 months. Results Among the 93 patients, median therapy time was 16 months （range：8 to 70 months）, and 21.5%（20/93） of them had received therapy for more than 2 years, while 8.6%（8/93） had received that for more than 3 years. hTe progression included 80%（72/90） for intrapleural progression, 38.9%（35/90） for primary tumor plus recurrence atfer sugary especially, 51.1%（46/90） for intrapulmonary metastasis, 25.6%（23/90） for pleural metastasis, 30%（30/90） for intracranial progression and 15.6%（14/90） for intraperitoneal progression. Conclusion Resistance to EGFR-TKI shows diversiifcation in clinical observation, therefore, close clinical follow-up is necessary for early attention and timely treatment.