无驱动基因突变的晚期非小细胞肺癌二线治疗的疗效观察

Therapeutic effect of second-line treatment for advanced non-small cell lung cancer without driver gene mutations

目的观察无驱动基因突变的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者二线治疗的疗效及不良反应,为无驱动基因突变的晚期NSCLC患者二线治疗提供理论依据和治疗策略。方法回顾性分析蚌埠医学院第一附属医院2019年7月至2020年12月期间收治的无驱动基因突变的晚期NSCLC患者90例。按照治疗方案分为3组,A组30例,采用多西他赛单药化疗,B组30例,采用安罗替尼+多西他赛联合治疗,C组30例,采用信迪利单抗+多西他赛联合治疗。分析3种二线治疗方案的临床疗效,评价其安全性与不良反应发生情况。结果C组的中位无进展生存期(progression-free survival,PFS)为7.3个月,中位总生存时间(overall survival,OS)为10.3个月,其中完全缓解(complete response,CR)0例,部分缓解(partial response,PR)11例(36.67%),疾病稳定(stable disease,SD)13例(43.33%),疾病控制率(disease control rate,DCR)为80.00%,客观缓解率(objective response rate,ORR)为36.67%,B组的中位PFS为6.6个月,中位OS为8.5个月,DCR为50.00%,ORR为23.33%,B组及A组的中位PFS、中位OS、DCR、ORR均低于C组,差异有统计学意义(P<0.05)。常见的不良反应有肝功能异常、皮肤及神经末梢反应、胃肠道反应、骨髓抑制、心血管事件等,组间比较差异无统计学意义(P>0.05)。结论信迪利单抗联合多西他赛治疗能够改善患者的OS、PFS,不良反应可控,为无驱动基因突变的晚期NSCLC二线治疗提供了选择。

Objective To observe the therapeutic effect and adverse reaction of second-line treatment in patients with advanced non-small cell lung cancer(NSCLC)without driver gene mutations,which aims to provide theoretical basis and treating strategies for second-line treatment of advanced NSCLC patients without driver gene mutations.Methods This study retrospectively analyzed 90 cases with advanced NSCLC without driver gene mutations who were admitted to the First Affiliated Hospital of Bengbu Medical College from July 2019 to December 2020.All patients were divided into three groups according to therapeutic schedules:group A(n=30)treated with docetaxel monotherapy;group B(n=30)treated with the combination of anlotinib and docetaxel;group C(n=30)treated with the combination of sintilimab and docetaxel.For the three types of second-line therapeutic schedules,their clinical efficacy was analyzed;the safety and adverse reactions were evaluated.Results In group C,the median progression-free survival(PFS)was 7.3 months;the median overall survival(OS)was 10.3 months.In this group,there were no patients with complete remission(CR),11 patients(36.67%)of partial remission(PR),13 patients(43.33%)of stable disease(SD).The disease control rate(DCR)was 80.00%;the objective response rate(ORR)was 36.67%.In group B,the median PFS was 6.6 months;the median OS was 8.5 months;the DCR was 50.00%;and the ORR was 23.33%.The median PFS,median OS,DCR and ORR in group B and group A were all lower than those in group C,and the differences were statistically significance(P<0.05).The common adverse reactions(including abnormal liver function,skin and nerve terminal reactions,gastrointestinal reactions,bone marrow suppression and cardiovascular events)had no significantly differences between the two groups(P>0.05).Conclusion Sintilimab combined with docetaxel treatment can improve the OS and PFS in patients with advanced NSCLC without driver gene mutations.with adverse reactions controllable.It provides a choice for the second-line treatment for advanced NSCLC without driver gene mutations.