酪氨酸激酶抑制剂与化疗交替联合治疗晚期肺腺癌的临床疗效

The Effect of Tyrosine Kinase Inhibitors Alternately Combined with Chemotherapy in the Treatment for Advanced Lung Adenocarcinoma

[目的]探讨酪氨酸激酶抑制剂（TKI）与化疗异时联合治疗晚期肺腺癌患者的疗效和不良反应。[方法]收集66例晚期肺腺癌患者，应用含铂2药化疗．疾病进展时予TKI吉非替尼或厄罗替尼治疗，或TKI初始治疗进展后使用化疗；交替进行。总生存时间及不良反应为主要观察指标；[结果]66例患者中，58例是化疗-TKI治疗模式，再化疗的有效率为15．5％，8例是TKI-化疗模式，再次TKI的有效率为25．0％，稍高于化疗-化疔模式患者中第二次治疗的有效率（12．7％）（χ2=2．6，,P=0．08）。化疗-TKI治疗与TKI-化疗患者的中位总体生存期（OS）无明显差异（18．3个月VS17．5个月）（P=-0．44），但明显长于化疗-化疗患者（6．9个月）（P=0．0001）。交替治疗患者的3-4度不良反应与对照人群相似。[结论]晚期肺腺癌患者TKI与化疗交替联合治疗能提高有效率，明显延长生存时间，与交替方式（给药顺序）无关。

[Purpose] To investigate the efficacy and adverse reactions of TKI metachronously alternately combined with chemotherapy in patients with advanced lung adenocarcinoma. [ Methods] A total of 66 patients with advanced lung adenocarcinoma patients treated with two- drug chemotherapy platinum-contained, and tyrosine kinase inhibitors（TKl） gefitinib or erlotinib, or TKI and chemotherapy alternately with disease progression after TKI initially. Thirty-one pa- tients with lung adenocarcinoma were as control. The primary endpoints of the study were overall survival and adverse reactions. [Results] Of 66 patients,58 cases were chemotherapy-TKI treatment mode,and response rate of second chemotherapy was 15.5%. Eight cases with TKI- chemotherapy mode again,the TKI response rate was 25.0%. The median overall survival （OS） was not significantly different between chemotherapy-TKI therapy and TKl-chemotherapy（18.3 months vs 17.5 months,P=-0.44）;but significantly longer than that of the control adenocarcinoma population without TKI （6.9 months, P=-0.0001）. Side effects of grade 3~4 in alternately treated patients were similar to control subjects. [Conclusion] TKI alternately combined with chemotherapy is able to improve prognosis significantly,which does not relate to treatment modalities （sequence of administration） in patients with advanced lung adenocarcinoma.