EGFR突变阳性的晚期非小细胞肺癌交替使用EGFR-TKI及放化疗的回顾性研究

Retrospective Study of Alternated EGFR-TKI and Chemoradiotherapy for EGFR Mutation-positive Advanced Non-small Cell Lung Cancer

目的:对EGFR基因敏感性突变的晚期非小细胞肺癌患者分别序贯进行放化疗-靶向-放化疗和靶向-放化疗-靶向治疗,回顾性地观察两种综合治疗模式的临床疗效及治疗相关副作用。方法:共收集携带EGFR基因敏感性突变的晚期非小细胞肺癌患者病例资料46份:26例患者接受放化疗-靶向-放化疗模式,20例患者接受靶向-放化疗-靶向治疗模式。两组患者在各自的一线治疗失败后都序贯进行二线治疗,获取患者的无疾病进展生存期1(progression-free survival 1,PFS1);二线治疗失败后序贯三线治疗,获取PFS2;三线治疗后最终随访至患者死亡,得出总生存期(overall survival,OS)。比较两组治疗模式的PFS1、PFS2、OS及治疗相关副作用。结果:两组患者在年龄、KPS、吸烟状况、EGFR突变状态、初始转移部位等临床特征上无显着性差异。接受靶向-放化疗-靶向治疗患者组的中位PFS1长于放化疗-靶向-放化疗组,差异无统计学意义(6.6个月vs 5.3个月,P=0.077);前者的中位PFS2也稍长于后者,但差异无统计学意义(6.3个月vs 5.0个月,P=0.646)。中位OS方面,两组患者的差异也无统计学意义(21.3个月vs 21.0个月,P=0.506)。靶向-放化疗-靶向组治疗发生治疗相关副作用相对较轻,但两组间腹泻、皮疹和Ⅲ～Ⅳ度骨髓抑制、恶心呕吐等副作用的差异均无统计学意义。结论:靶向-放化疗-靶向序贯治疗模式组的PFS1、PFS2和OS均具有优于放化疗-靶向-放化疗模式组的趋势,且治疗相关副作用也具有较轻的趋势。

Objective:To retrospectively observe the clinical efficacy and adverse effects of two sequential therapeutic modes,chemoradiotherapy-EGFR-TKI-chemoradiotherapy (RCT-TKI-RCT)and EGFR-TKI-chemoradiotherapy-EGFR-TKI (TKI-RCT-TKI),in advanced non-small cell lung cancer (NSCLC)patients with positive EGFR gene mutation.Methods: The information of 46 advanced NSCLC patients with positive EGFR gene mutation were collected.Twenty-six patients were treated with RCT-TKI-RCT and 20 patients with TKI-RCT- TKI.The patients in both groups were followed by second-line treatment after their first-line treatment failed,and their progression-free survivals (PFS)1 were recorded.After failure of second-line treatment,third-line treatment was performed and PFS2 was obtained.All patients were followed up until they died,and overall survival (OS)of them was obtained.PFS1, PFS2,OS and adverse effects of both group were evaluated.Results:There were no statistically significant differences between the two groups in clinical features,including age,KPS,history of tobacco use,EGFR mutation status and initial metastasis site.The median PFS1 of patients in the TKI-RCT-TKI group was longer than that of patients in the RCT-TKI-RCT group.The difference is not statistically significant (6.6 months vs 5.3 months,P =0.077).The median PFS2 of the former was also longer than that of the latter.The difference was not statistically significant (6.3 months vs 5.0 months,P = 0.646).There was also no statistically significant difference in median OS between the TKI-RCT-TKI group and the RCT-TKI-RCT group (21.3months vs 21.0 months,P =0.506).The adverse effects of the TKI-RCT-TKI group were relatively shghter,but there were no statistically significant differences between the two groups in diarrhea,rash,hematotoxicity of Ⅲ ~Ⅳ degree,nausea and vomiting etc.Conclusion:PFS1,PFS2 and OS of the TKI-RCT-TKI group were longer than those of the RCT-TKI-RCT group,and the adverse effects of the former were slighter.