盐酸埃克替尼治疗晚期非小细胞肺癌的临床观察

Clinical study of icotinib in treatment of advanced non-small cell lung cancer

目的评价盐酸埃克替尼治疗晚期非小细胞肺癌（NSCLC）的疗效及不良反应,并观察治疗前的EGFR基因检测情况。方法对2011年12月-2013年12月口服盐酸埃克替尼治疗的90例晚期NSCLC患者的临床资料进行回顾性分析。EGFR基因检测采用ARMS法。结果盐酸埃克替尼治疗肺癌患者EGFR基因检测率为48.9%。盐酸埃克替尼一线、二线治疗组的EGFR基因检测率分别为79.5%、30.0%（P〈0.05）。可评价疗效的89例患者中,完全缓解（CR）0例,部分缓解（PR）31例（34.8%）,疾病稳定（SD）38例（42.7%）,疾病进展（PD）20例（22.5%）。客观缓解率（ORR）为34.8%,疾病控制率（DCR）为77.5%。89例患者中位无进展生存期（PFS）为6.7个月（0.6-17.8个月）,中位总生存时间（OS）为8.2个月（1.1-31个月）。主要不良反应为皮肤毒性和胃肠道毒性,经对症处理后能耐受。结论盐酸埃克替尼治疗晚期NSCLC具有明显的疗效以及良好的安全性,化疗可能降低EGFR基因突变的阳性率。现阶段肺癌患者EGFR基因突变的检测率较低,临床工作中应加强基因检测。

Objective To evaluate the clinical efficacy and toxicity of icotinib in the treatment of advanced non-small cell lung cancer （NSCLC） and the detection of EGFR gene before treatment. Methods A total of 90 advanced NSCLC patients received icotinib treatment from December 2011 to December 2013, and the clinical data were analyzed retro- spectively. ARMS was applied in the detection of EGFR mutations. Results The detection rate of EGFR mutation in all patients was 48.9%, with 79.5% and 30.0% in first line group and second line group respectively （P〈0.05）. 89 patients were evaluable for objective response, and the results showed no patients got a complete response （CR）, 31（34.8%） cases with a partial response （PR）, 38（42.7%） cases with a stable disease （SD）, and 20（22.5%） cases had a progressive disease （PD）. The objective response rate （ORR） was 34.8%, and the disease control rate （DCR） was 77.5%. The median progres- sion-free survival （PFS） was 6.7 months （0.6-17.8 months）, and the median overall survival time was 8.2 months （1.1- 31 months）. The common adverse effects were hematological and gastrointestinal toxicities, and the toxicities could be well controlled with relative therapy. Conclusion Icotinib is effective and well tolerable for advanced NSCLC. Chemotherapy may reduced the rate of EGFR mutation. The detection rate of EGFR mutation before icotinib treatment is relatively low, which may be enhanced in future clinical work.