吉非替尼治疗不同EGFR突变类型非小细胞肺癌患者的疗效比较

Efficacy of gefitinib for treating non-small cell lung cancer with different types of epidermal growth factor receptor

目的观察吉非替尼治疗不同表皮生长因子受体(EGFR)突变类型非小细胞肺癌(NSCLC)患者的效果,并评价其安全性。方法选取我院2014年1月至2016年1月收治的54例EGFR突变型NSCLC患者,其中外显子19缺失者(19突变组)31例,外显子21L858R缺失者(21突变组)23例,所有患者均予以口服吉非替尼治疗,直至患者病情进展或出现不可耐受的毒副作用而停药,比较不同突变类型患者的临床疗效及不良反应情况。结果 19突变组患者中位无疾病进展生存期(PFS)为9.0个月(95%CI 8.09~9.91个月),较21突变组患者的6.8个月(95%CI6.48~7.12个月)延长,差异具有统计学意义(P<0.05);19突变组患者的中位总生存期(OS)为15.2个月(95%CI 14.48~15.92个月),较21突变组患者的12.3个月(95%CI 7.89~16.70个月)延长,差异具有统计学意义(P<0.05)。皮疹及腹泻为最常见不良反应,但总体上两组不良反应差异无统计学意义(P>0.05)。结论 EGFR基因外显子19突变者经吉非替尼治疗显著有效,提示该突变可能预测NSCLC患者对吉非替尼疗效。

Objective To evaluate the efficacy and safety of gefitinib in the treatment of non-small cell lung cancer（NSCLC） patients with different EGFR mutations. Methods From January 2014 to January 2016, 54 patients of EGFR mutant NSCLC were treated in our hospital, including 31 patients of exon 19 deletions（exon 19 mutation group）,and 23 patients of exon 21L858 R mutations（exon 20 mutation group）. All patients had gefitinib treatment（orally, 250mg/time, 1 time/day） until disease progression or intolerable side effects. The clinical efficacy and adverse reactions were compared between different types of mutations. Results The progression-free survival（PFS） and median overall survival（OS） of the exon 19 mutations in NSCLC patients after gefitinib treatment were significantly higher compared with those of the exon 21 mutations, 9.0 months（95% CI 8.09~9.91 months） vs 6.8 months（95% CI 6.48~7.12months）, 15.2 months（95% CI 14.48~15.92 months） vs 12.3 months（95% CI 7.89~16.70 months）, both P〈0.05. Rash and diarrhea were the most common adverse reactions, but there was no significant difference between the two groups（P〈0.05）. Conclusion Gefitinib is effective for treating NSCLC with exon 19 mutations, suggesting that the mutations may predict the efficacy of gefitinib in NSCLC patients.