EGFR-TKI治疗非小细胞肺癌EGFR突变阳性脑转移的临床对比观察

Observation of clinical efficacy of EGFR-TKI for brain metastases in non-small cell lung cancer with EGFR mutation

目的探讨EFGR-TKI(厄洛替尼与吉非替尼)治疗非小细胞肺癌(NSCLC)EGFR突变阳性脑转移患者的临床疗效。方法回顾收集分析我科73例EGFR突变阳性的肺腺癌脑转移患者的临床病历资料,患者均口服厄洛替尼150mg/d(39例)或吉非替尼250 mg/d(34例),服药直至患者颅内外病情进展、死亡、出现不可耐受的副反应或不能控制的新发病灶。结果厄洛替尼组与吉非替尼组颅内病变的有效率(RR)和疾病控制率(DCR)分别为51.3%,94.9%和53.0%,94.1%(P=0.861),两组颅外病变的有效率和疾病控制率分别为59.0%,97.4%和50.0%,97.1%(P=0.793),两组患者的中位无进展生存期(PFS)和总生存期(OS)分别为11.3个月和15.1个月vs12.1个月和16.4个月(P=0.913,P=0.641)。两种药物的副反应均较小,患者都可以耐受。结论 EGFR-TKI对EGFR突变阳性的NSCLC脑转移均具有较好地疗效,可作为EGFR突变阳性脑转移患者的一线或二线治疗,药物副反应较小,两种药物对患者的预后无明显差异。

Objective To evaluate the clinical efficacy of EGFR-TKI （ erlotinib and gefitinib） for brain me- tastases in non-small cell lung cancer patents with EGFR mutation. Methods A total of 73 brain metastases patients of pulmonary adenocarcinoma with EGFR mutation were retrospectively analyzed, and all of them were treated with oral erlotinib （150mg,/d, 39 patients） or gefitinib （250mg/d, 34 patients）. The treatment would be stopped when the intraeranial disease progressed or death, intolerable side effect or uncontrolled new lesions appeared. Results The response rate （RR） and disease control rate （DCR） of intracranial disease were 51.3% , 94. 9% and 53.0% , 94. 1% in the two groups respectively （P =0. 861 ）. The RR and DCR of extracranial disease were 59. 0% , 97. 4% and 50. 0%, 97. 1% in both groups respectively （P =0. 793）. The median progression free survival （PFS） and o- verall survival time （OS） were 11.3 months and 15. 1 months vs 12. 1 months and 16. 4 months （P =0. 913, P = 0. 641 ） in the two groups. There was little side effect, which could all be tolerated. Conclusion EGFR-TKI shows significant effect on brain metastases in NSCLC patients with EGFR mutation, and it can be used as the first-line or second-line treatment with less toxicity. Erlotinib and gefitinib show no difference in prognosis of patients.