含铂双药化疗EGFR-TKI耐药及未突变晚期肺腺癌临床观察

Clinical Observation of Pemetrexed Plus Carboplatin Chemotherapy as Treatment of EGFR-TKI Resistant and Nomutated in Advanced Lung Adenocarcinoma

目的:比较培美曲塞联合卡铂治疗EGFR-TKI耐药及未突变晚期肺腺癌的效果。方法:回顾性分析2017年10月-2019年12月在成都市第三人民医院治疗确诊的晚期肺腺癌(ⅢB/Ⅳ期)患者35例,20例EGFR 19Del、21L858R位点突变阳性患者(突变耐药组)在奥希替尼治疗耐药进展后给予化疗培养曲塞联合卡铂;15例EGFR未突变患者(未突变组)直接给予化疗。连用4个周期,进行疗效及不良反应评价。结果:35例患者中,未突变组患者总有效率及疾病控制率均高于突变耐药组患者(40.0%vs 35.0%、73.3%vs 70.0%),但两组比较差异无统计学意义(P>0.05)。中位无进展生存期(media progression-free survival,mPFS)中,未突变组患者mPFS(8.9个月)长于突变耐药组患者(6.1个月),差异无统计学意义(P=0.087)。全组总有效率为37.1%,疾病控制率为71.4%。Cox回归分析:对PFS有影响的因子为突变位点(P=0.038)。两组患者Ⅲ~Ⅳ级不良反应发生率比较差异无统计学意义(P>0.05),主要表现为:胃肠道反应、骨髓抑制和皮疹。结论:培美曲塞联合卡铂治疗晚期肺腺癌EGFR未突变与EGFR-TKI耐药患者效果相近,不良反应可耐受。

Objective:To compare the effects of Pemetrexed combined with Carboplatin in the treatment of EGFR-TKI resistant and no-mutated advanced lung adenocarcinoma.Method:A retrospective analysis was carried out for 35 patients with advanced lung adenocarcinoma(stageⅢB/Ⅳ)who admitted to the Third People’s Hospital of Chengdu from October 2017 to December 2019.A total of 20 patients with EGFR 19Del,21L858R sits mutation positive(mutations resistance group)were treated with chemotherapy(Pemetrexed combined with Carboplatin)after the progression of Osimertinib treatment resistance,and 15 patients of no-mutation EGFR mutation(no-mutation group)were treated with chemotherapy directly.The efficacy and adverse reactions were evaluated after 4 cycles of continuous use.Result:In the 35 patients,the total effective rate and disease control rate of no-mutation group were higher than those of EGFR gene mutation resistance group(40.0%vs 35.0%,73.3%vs 70.0%),but there were no statistical significant differences between the two groups(P>0.05).In media progression-free survival(mPFS),the mPFS(8.9 months)of no-mutation group was longer than that of patients with mutation resistance group(6.1 months),but the difference was not statistically significant(P=0.087).The total effective rate was 37.1%and the disease control rate was 71.4%.Cox regression analysis showed that mutation sites was the influential factors on PFS(P=0.038).There was no significant difference in the incidence of gradeⅢ-Ⅳadverse reactions between two groups(P>0.05),and the main manifestations were gastrointestinal reactions,bone marrow suppression and rash.Conclusion:Pemetrexed combined with Carboplatin has similar efficacy in advanced adenocarcinoma of lung without EGFR mutation and EGFR-TKI resistance,and adverse reactions can be tolerated.