表皮生长因子受体酪氨酸激酶抑制剂治疗晚期非小细胞肺癌及肺癌合并颅脑转移的临床分析

Treatment of epidermal growth factor receptor-tyrosine kinase inhibitor in advanced non-small cell lung cancer and lung cancer with brain metastasis

目的探讨表皮生长因子受体一酪氨酸激酶抑制剂（EGFR—TKI）治疗晚期非小细胞肺癌（NSCLC）以及肺癌合并脑转移患者的疗效、预后及不良反应。方法回顾性分析2007年1月至2012年8月福建省立医院收治的接受EGFR—TKI治疗的晚期NSCI。C患者临床资料，所有患者口服EGFR—TKI直到病变进展或出现不可耐受的不良反应。结果52例晚期NSCI。C患者接受EGFR—TKI治疗的客观缓解率（ORR）为34．6％（18／52），疾病控制率（DCR）为75．0％（39／52），中位无进展生存期（PFS）为6．O个月，中位总生存期（MST）为18．O个月。腺癌、不吸烟、服药前肿瘤大小〈5cm的患者DCR高于非腺癌、吸烟、服药前肿瘤大小≥5cm者（P〈O．05）。生存分析示服药前肿瘤大小〈5cm、疾病控制者的中位PFS优于服药前肿瘤大小≥5cm、疾病进展者（P〈0．05）。而无吸烟史、服药前肿瘤大小〈5cm者的MST优于有吸烟史、服药前肿瘤大小≥5cm者（P〈0．05）。21例肺癌合并脑转移患者口服EGFR-TKI治疗后颅内病灶的ORR为38．1％，DCR为90．5％；全身病变的ORR为38．1％，DCR为85．7％。本研究中最常见的不良反应为皮疹（25．0％）、皮肤瘙痒（19．2％）。结论EGFR—TKI治疗晚期NSCI。C是有效、安全的；EGFR—TKI对脑转移存在一定疗效。

Objective To explore the efficacy, prognosis, and side effects of epidermal growth factor receptor-tyrosine kinase inhibitor （EGFR-TKI） therapy for advanced non-small cell lung cancer and lung cancer with brain metastasis, Methods Clinical datas of advanced non-small cell lung cancer who received EGFR-TKI treatment in Fujian Provincial Hospital from January 2007 to August 2012 were retrospectively analyzed. All patients received EGFR-TKI until the disease progression or intolerable toxicity. Results The objective response rate （ORR） and the disease control rate （DCR） after administration of EGFR-TKI were 34.6% （ 18/52 ） and 75.0% （ 39/52 ）, respectively. The median progression free survival time and overall survival time were six months and 18 months, respectively. The DCR in patients with adenocarcinoma, non-smoking, and tumor size ≥ 5 cm was higher than that in patients with non-adenocarcinoma, smokers and tumor size ≥ 5 cm （P 〈 0.05）. Survival analysis suggested that the median progression survival in patients with tumor size %5 em and stable disease was longer than that in patients with tumor size ≥5 cm and progression disease （ P〈 0.05）. The median survival time in non-smokers and patients of tumor size ≥ 5 cm was longer than that in smokers and patients of tumor size ≥5 cm （ P〈0.05）. Among 21 cases of lung cancer with brain metastasis treated with EGFR-TKI,overall ORR and DCR of intracranial lesions were 38.1% and 90.5 %, respectively. The ORR and DCR of systemic disease were 38.1% and 85.7 %, respectively. The most common side effectswere rash （25.0%） and pruitus （19.2%）. Conclusions of advanced non-small cell lung cancer patients. EGFR cancer patients. EGFR-TKI is effective and safe in the treatment FKI may be effective on brain metastases in brag