贝伐珠单抗与安罗替尼分别联合化疗药用于EGFR-TKI获得性耐药晚期肺腺癌的临床观察

Clinical observation of bevacizumab versus anlotinib respectively combined with chemotherapy drug in the treatment of EGFR-TKI acquired resistant advanced lung adenocarcinoma

目的比较贝伐珠单抗与安罗替尼分别联合化疗药用于表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)获得性耐药晚期肺腺癌的近期疗效和安全性。方法回顾性分析2019年6月-2021年10月成都市第三人民医院治疗的84例EGFR-TKI获得性耐药晚期肺腺癌患者资料,按用药的不同分为化疗组(32例)、安罗替尼联合化疗组(24例)和贝伐珠单抗联合化疗组(28例)。化疗组患者给予注射用培美曲塞二钠+卡铂注射液,并对症治疗不良反应;安罗替尼联合化疗组患者在化疗组用药的基础上,于化疗第1天口服盐酸安罗替尼胶囊10 mg,每日1次,连续用药14 d,停药7 d;贝伐珠单抗联合化疗组患者在化疗组用药的基础上,于化疗前1 d给予贝伐珠单抗注射液15 mg/kg,静脉滴注。3组患者均以每3周为1个周期,共治疗4个周期。比较3组患者的总有效率(ORR)、疾病控制率(DCR)、中位无进展生存期(mPFS),治疗前后血清中肿瘤标志物水平变化,并记录不良反应发生情况及随访1年的生存率。结果治疗4个周期后,两个联合化疗组患者的ORR、DCR均显著高于化疗组,mPFS均显著长于化疗组,且安罗替尼联合化疗组患者的DCR显著高于贝伐珠单抗联合化疗组(P<0.05)。治疗4个周期后,3组患者血清中肿瘤标志物水平均显著低于同组治疗前,且两个联合化疗组均显著低于化疗组(P<0.05)。3组患者恶心呕吐、骨髓抑制等不良反应发生率及1年生存率比较,差异均无统计学意义(P>0.05)。结论贝伐珠单抗与安罗替尼分别联合化疗药用于EGFR-TKI获得性耐药晚期肺腺癌的疗效和安全性均较好。

OBJECTIVE To compare the short-term therapeutic effect and safety of bevacizumab versus anlotinib respectively combined with chemotherapy drug in the treatment of epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKI)acquired resistant advanced lung adenocarcinoma.METHODS The information of 84 patients with EGFR-TKI acquired resistant advanced lung adenocarcinoma in the Third People’s Hospital of Chengdu was analyzed retrospectively during Jun.2019-Oct.2021.The patients were divided into chemotherapy group(32 cases),anlotinib combined chemotherapy group(24 cases)and bevacizumab combined chemotherapy group(28 cases).Patients in the chemotherapy group were given Pemetrexed disodium for injection and Carboplatin injection,and symptomatic treatment was given for adverse reactions.On the first day of chemotherapy,patients in the anlotinib combined chemotherapy group received Anlotinib hydrochloride capsules 10 mg orally,once a day,for 14 consecutive days and 7 days of discontinuation,based on the treatment of the chemotherapy group.Patients in the bevacizumab combined chemotherapy group were given Bevacizumab injection of 15 mg/kg intravenously 1 day before chemotherapy,based on the treatment of the chemotherapy group.Three groups of patients were treated for a total of four cycles,with one cycle every three weeks.The overall response rate(ORR),disease control rate(DCR),median progression-free survival(mPFS),and the changes of serum tumor markers were compared among three groups before and after treatment;meanwhile,the occurrence of adverse drug reactions was recorded,and the 1-year survival rate was followed up.RESULTS After 4 treatment cycles,ORR and DCR of bevacizumab combined chemotherapy group and anlotinib combined chemotherapy group were higher than chemotherapy group(P<0.05);mPFS of the two groups were significantly longer than chemotherapy group,and DCR of anlotinib combined chemotherapy group was significantly higher than bevacizumab combined chemotherapy group(P<0.05).After 4 treatment cycles,the serum levels of tumor markers in three groups were significantly lower than before treatment,and both combined chemotherapy groups were significantly lower than chemotherapy group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions such as nausea,vomiting,bone marrow suppression,and 1-year survival rate among the three groups of patients(P>0.05).CONCLUSIONS Bevacizumab and anlotinib combined with chemotherapy drug are effective and safe in the treatment of advanced lung adenocarcinoma with acquired EGFR-TKI resistance.