吉非替尼与含铂类化疗联合时序对EGFR突变型肺腺癌患者的临床疗效对比

Comparison of the Therapeutic Effects of Gefitinib Targeting Therapy and Platinum-containing Chemotherapy on EGFR Mutant Lung Adenocarcinoma

目的研究吉非替尼与含铂类化疗联合时序对EGFR基因突变型肺腺癌患者的临床疗效及安全性。方法将初治的EGFR基因突变的晚期肺腺癌患者126例按照联合时序不同分为(Gef+MP)组和(MP+Gef)组。Gef+MP组患者接受吉非替尼序贯培美曲塞+顺铂方案化疗,MP+Gef组患者接受培美曲塞+顺铂序贯吉非替尼方案化疗。对比2组患者的客观缓解率(ORR)、疾病控制率(DCR)和3年无进展生存期(PFS),对比2组患者不良反应发生情况。结果 MP+Gef组ORR和DCR显著高于Gef+MP组(78.69%vs 60.00%,P<0.05;90.16%vs 72.31%,P<0.05)。MP+Gef组中位PFS显著高于Gef+MP组(18.9 vs 9.9,P<0.05)。MP+Gef组的恶心、腹泻、疲劳、呕吐等不良反应的发生率显著低于Gef+MP组(P<0.05),其他不良反应发生率无统计学差异(P>0.05)。结论 MP方案序贯吉非替尼可以显著改善EGFR基因突变晚期肺腺癌患者的ORR和DCR,提高患者的PFS,且不良反应较少且轻。

Objective To study the clinical efficacy and safety of gefitinib and platinum-containing chemotherapy for patients with mutant EGFR advanced lung adenocarcinoma. Methods 126 patients with advanced lung adenocarcinoma with mutant EGFR gene were divided into Gef ＋ MP group and MP ＋ Gef group according to the combined timing. Patients in the Gef ＋ MP group received chemotherapy with gefitinib sequentially with pemetrexed ＋ cisplatin,while patients in the MP ＋ Gef group received chemotherapy with pemetrexed ＋ cisplatin sequentially with gefitinib. Compared the objective response rate（ ORR）,the disease control rate（ DCR）,Progression-Free Survival（ PFS） and the adverse reactions between the 2 groups. Results The ORR and DCR of MP ＋ Gef group were significantly higher than those of Gef ＋ MP group（ 78. 69% vs 60. 00%,P 〈 0. 05; 90. 16% vs72. 31%,P 〈 0. 05）. The median PFS of MP ＋ Gef group was significantly higher than that of Gef ＋ MP group（ 18. 9 vs 9. 9,P 〈 0. 05）. The incidence of adverse reactions of MP ＋ Gef group were significantly lower than those of Gef ＋ MP group（ P 〈0. 05）,such as nausea,diarrhea,fatigue and vomiting etc. Other adverse reactions had no significant difference（ P 〉 0. 05）. Conclusion MP combined with gefitinib can significantly improve ORR and DCR in patients with advanced lung adenocarcinoma of EGFR mutations and improve PFS with minimal and less adverse effects.