表皮生长因子受体基因突变晚期非小细胞肺癌靶向药物治疗的临床效果

Clinical effect of targeted drug therapy in advanced non-small cell lung cancer with epidermal growth factor receptor gene mutation

目的观察表皮生长因子受体(EGFR)基因突变晚期非小细胞肺癌靶向药物治疗的临床效果。方法选取2018年1月—2019年12月河南省民权县中医院收治的EGFR基因突变晚期非小细胞肺癌患者96例,根据随机数字表法分为观察组和对照组,每组48例。对照组采用常规化疗(吉西他滨+顺铂),在此基础上,观察组使用盐酸埃克替尼片治疗。比较2组患者近期疗效,治疗前后肿瘤标志物水平、免疫功能指标变化,不良反应及生存时间。结果观察组患者近期总缓解率为54.17%、疾病控制率为79.17%,均高于对照组的25.00%、58.33%(χ^(2)=8.537,P=0.003;χ^(2)=4.848,P=0.028);治疗3~4个周期后,2组癌胚抗原(CEA)、糖类抗原199(CA199)、血管内皮生长因子(VEGF)水平均较治疗前降低,且观察组低于对照组(P均<0.01);2组CD4^(+)、CD4^(+)/CD8^(+)均较治疗前提高,CD8^(+)较治疗前下降,且观察组治疗后CD4^(+)、CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组,差异均有统计学意义(P<0.05或P<0.01);观察组白细胞减少、血小板减少、恶心呕吐发生率均低于对照组(P<0.01),2组血红蛋白减少、皮疹、腹泻、肝功能损伤发生率比较差异均无统计学意义(P>0.05);观察组无进展生存期、总生存期均长于对照组(P<0.01)。结论EGFR基因突变晚期非小细胞肺癌患者使用靶向药物治疗的临床效果显著,能增强对肿瘤的抑制力,改善免疫功能,延长生存时间,不增加不良反应发生率,为临床治疗提供了新方法。

Objective To observe the clinical effect of targeted drug therapy in advanced non-small cell lung cancer(NSCLC)with epidermal growth factor receptor(EGFR)gene mutation.Methods A total of 96 patients with advanced NSCLC with EGFR gene mutation who were admitted to Minquan County Hospital of Traditional Chinese Medicine from January 2018 to December 2019 were selected and divided into an observation group and a control group according to the random number table method,with 48 cases in each group.The control group was treated with conventional chemotherapy(gemcitabine+cisplatin),and on this basis,the observation group was treated with icotinib hydrochloride tablets.The short-term curative effects,tumor marker levels and immune function indexes before and after treatment were compared between the two groups;The incidence of adverse reactions and the survival time of the two groups were compared.Results The recent overall remission rate and disease control rate of the observation group were 54.17%and 79.17%,which were higher than those of the control group,25.00%and 58.33%(χ^(2)=8.537,P=0.003;χ^(2)=4.848,P=0.028).After 3~4 cycles of treatment,the levels of carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199)and vascular endothelial growth factor(VEGF)in the two groups were lower than those before treatment,and the observation group was lower than the control group(all P<0.01);CD4^(+),CD4^(+)/CD8^(+)in both groups were increased compared with those before treatment,and CD8^(+)was decreased compared with before treatment,after treatment,CD4^(+),CD4^(+)/CD8^(+)of observation group were higher than those of control group,and CD8^(+)was lower than that of control group(P<0.05 or P<0.01).The incidences of leukopenia,thrombocytopenia,nausea and vomiting in the observation group were lower than those in the control group(P<0.01),and there was no significant difference in the incidences of hemoglobin,rash,diarrhea,and liver function damage between the two groups(P>0.05).The progression-free survival and overall survival in the observation group were longer than those in the control group(P<0.01).Conclusion Targeting EGFR gene mutation in advanced NSCLC has significant clinical effects,which can enhance tumor inhibition,improve immune function,prolong survival time,and do not increase the incidence of adverse reactions,providing a new method for clinical treatment.