非小细胞肺癌获得性表皮生长因子受体酪氨酸激酶抑制剂耐药治疗疗效观察

Efficacy of therapy for non-small cell lung cancer acquired epidermal growth factor receptor tyrosine kinase inhibitor resistance

目的探讨非小细胞肺癌(NSCLC)患者获得性表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)耐药后后续化疗联合沙利度胺和化疗序贯EGFR-TKIs治疗的疗效。方法选取2016年1月至2017年2月间安徽省芜湖市第二人民医院收治的经EGFR-TKIs治疗起效并出现获得性耐药的41例NSCLC患者,采用随机数字生成法分为A组和B组。A组21例患者采用多西他赛、培美曲赛和顺铂化疗,联合沙利度胺口服治疗; B组20例患者采用多西他赛、培美曲赛和顺铂化疗,序贯EGFR-TKIs治疗。比较两组患者的近期疗效、中位无进展生存时间(PFS)及不良反应。结果两组患者近期疗效比较,差异无统计学意义(P> 0. 05)。两组患者中位PFS比较,差异无统计学意义(P> 0. 05)。A组患者便秘发生率高于B组,恶心、呕吐发生率低于B组,组间差异均有统计学意义(均P <0. 05)。结论常规化疗联合沙利度胺和常规化疗序贯EGFR-TKIs治疗均可作为获得性EGFR-TKIs耐药NSCLC晚期患者的后续治疗方案,临床可根据实际情况选用。

Objective To explore the efficacy of subsequent chemotherapy combined with thalidomide and sequential chemotherapy for non-small cell lung cancer( NSCLC) acquired epidermal growth factor receptor tyrosine kinase inhibitors( EGFR-TKIs) resistance. Methods A total of 41 patients with NSCLC who received EGFR-TKIs and acquired resistance at Second People’s Hospital of Wuhu from January2016 to February 2017. They were divided into group A( 21 patients) and group B( 20 patients) by computer random number generation. Patients in group A were given combination chemotherapy with docetaxel,pemetrexed,cisplatin plus oral thalidomide,and patients in group B were treated with docetaxel,pemetrexed,cisplatin and EGFR-TKIs sequential chemotherapy. The short-term efficacy,progression free survival( PFS) and adverse reactions were compared between the two groups. Results There was no significant difference in the short-term efficacy be tween the two groups( P > 0. 05). There was no significant difference in median PFS between the groups( P > 0. 05). The incidence of constipation,and nausea and vomiting in group A was significantly higher than group B( all P < 0. 05). Conclusion Both thalidomide and sequential EGFR-TKIs chemotherapy can be used as a subsequent treatment for advanced EGFR-TKIs resistant NSCLC. The clinicians make the decision according to the actual situation..