EGFR-TKI二次給藥聯(lián)合抗血管生成藥物治療晚期NSCLC的臨床療效觀察
發(fā)布時(shí)間：2018-08-20 17:38
【摘要】：目的:晚期NSCLC患者經(jīng)EGFR-TKI治療出現(xiàn)耐藥現(xiàn)象不可避免,延緩EGFR-TKI耐藥成為近年來熱門話題,本研究旨在探討EGFR-TKI二次給藥聯(lián)合抗血管生成藥物治療晚期NSCLC的臨床療效,預(yù)后影響因素及不良反應(yīng)。方法:依據(jù)入組標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)選取2010年1月1日至2017年2月1日就診于山西省腫瘤醫(yī)院呼吸二病區(qū)的病理組織學(xué)確診的晚期NSCLC患者,患者既往都接受過EGFR-TKI治療,獲益一段時(shí)間后出現(xiàn)疾病進(jìn)展,繼續(xù)接受EGFR-TKI二次用藥并且聯(lián)合抗血管生成藥物治療。收集患者完整臨床資料并進(jìn)行回顧性的臨床分析,患者的療效評(píng)價(jià)嚴(yán)格按照實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)(RECIST)進(jìn)行評(píng)價(jià)。并對(duì)本研究中全組患者的臨床特征及療效、生存分析進(jìn)行統(tǒng)計(jì)分析,均采用SPSS統(tǒng)計(jì)學(xué)方法分析:其中影響患者療效的臨床因素使用X2檢驗(yàn)及Fisher精確概率法,用Kaplan-Meier法進(jìn)行生存分析,使用Log-rank時(shí)序檢驗(yàn)進(jìn)行預(yù)后單因素分析,使用COX回歸模型進(jìn)行多因素分析。結(jié)果:1.臨床特征:本研究40例晚期NSCLC患者總體年齡分布范圍在42-71歲,其中男性20人,女性20人。ECOG評(píng)分為0-1分者30例,≥2分者10人。無吸煙史者23例,有吸煙史者17例。臨床分期IIIB期17人,IV期23人。4 0例患者使用靶向藥物EGFR-TKI:吉非替尼13例,厄洛替尼20例,埃克替尼7例。病理類型均為腺癌�；颊咧委熯^程中發(fā)現(xiàn)EGFR基因突變患者26例,野生型8例,未知6例。聯(lián)合治療前有遠(yuǎn)處轉(zhuǎn)移的患者23例,無遠(yuǎn)處轉(zhuǎn)移的患者17例。治療時(shí)機(jī):EGFR-TKI聯(lián)合抗血管生成治療二線使用者有7例,三線及以上使用的者33例。2.療效:40例晚期NSCLC患者接受EGFR-TKI二次給藥聯(lián)合抗血管生成治療后,療效評(píng)價(jià),CR:0例,PR:9例,SD:17例,PD:14例,ORR為22.5%(9/40),DCR為65%(26/40)。其中EGFR基因突變患者DCR明顯高于EGFR陰性的患者(P0.05)。3.預(yù)后:生存分析結(jié)果顯示:本研究患者中位無進(jìn)展生存期mPFS:6個(gè)月,中位總生存期MST:10個(gè)月;單因素Log-rank時(shí)序檢驗(yàn)提示治療前無遠(yuǎn)處轉(zhuǎn)移、分期IIIB期、EGFR基因突變、PS 0-1分、疾病控制者其中位PFS明顯優(yōu)于治療前有遠(yuǎn)處轉(zhuǎn)移、分期IV期、EGFR野生型、PS評(píng)分≥2分、疾病進(jìn)展者(P0.05)。EGFR突變、疾病控制、PS評(píng)分0-1分患者的MST優(yōu)于EGFR野生型、疾病進(jìn)展、PS評(píng)分≥2分患者。COX多因素回歸顯示治療前有遠(yuǎn)處轉(zhuǎn)移、疾病進(jìn)展、PS≥2分、EGFR野生型為影響中位PFS的危險(xiǎn)因素。PS≥2分是影響MST的獨(dú)立危險(xiǎn)因素。4.不良反應(yīng):EGFR-TKI聯(lián)合抗血管生成治療晚期NSCLC患者最常見的不良反應(yīng)為皮疹、厭食等。結(jié)論:1.晚期非小細(xì)胞肺癌EGFR-TKI耐藥現(xiàn)象出現(xiàn)后接受EGFR-TKI二次用藥聯(lián)合抗血管生成治療療效顯著、安全。EGFR基因突變是影響治療療效的有利因素。2.EGFR-TKI二次給藥聯(lián)合抗血管生成治療晚期NSCLC預(yù)測(cè)生存期mPFS:6個(gè)月,MST:10個(gè)月。治療前遠(yuǎn)處轉(zhuǎn)移情況、分期、EGFR、PS評(píng)分、療效與預(yù)后有相關(guān)性。COX多因素回歸提示治療前有遠(yuǎn)處轉(zhuǎn)移、疾病進(jìn)展、PS≥2分、EGFR野生型為影響中位PFS的危險(xiǎn)因素。PS≥2分評(píng)分是影響患者M(jìn)ST的獨(dú)立危險(xiǎn)因素。
[Abstract]:OBJECTIVE: Drug resistance in patients with advanced NSCLC is inevitable after EGFR-TKI treatment. Delaying EGFR-TKI resistance has become a hot topic in recent years. The purpose of this study was to investigate the clinical efficacy, prognostic factors and adverse reactions of EGFR-TKI combined with antiangiogenic drugs in the treatment of advanced NSCLC. Patients with advanced NSCLC who were diagnosed by histopathology in the respiratory ward of Shanxi Cancer Hospital from January 1, 2010 to February 1, 2017 were treated with EGFR-TKI in the past. After a period of benefit, the patients developed disease progression and continued to receive EGFR-TKI secondary treatment and combined with anti-angiogenesis drugs. The clinical characteristics, curative effect and survival analysis of all the patients in this study were analyzed by SPSS. The clinical factors affecting the efficacy of the patients were analyzed by X2 test. Results: 1. Clinical features: The overall age distribution of 40 patients with advanced NSCLC ranged from 42 to 71 years old, including 20 males and 20 females. The ECOG score was 0-1. Thirty patients were diagnosed as having no history of smoking, 17 as having a history of smoking, 17 as having a history of smoking, and 17 as having a history of smoking. 23 patients with distant metastasis and 17 patients without distant metastasis were treated with EGFR-TKI combined with anti-angiogenesis therapy. 17 cases, PD: 14 cases, ORR 22.5% (9/40), DCR 65% (26/40). The DCR of EGFR gene mutation patients was significantly higher than that of EGFR negative patients (P 0.05). Stage IIIB, EGFR gene mutation, PS 0-1, disease control patients with median PFS significantly better than before treatment, stage IV, EGFR wild type, PS score (> 2), disease progression (P 0.05). EGFR mutation, disease control, PS score 0-1 in patients with MST than EGFR wild type, disease progression, PS score (> 2) multivariate regression showed that. Before treatment, distant metastasis, disease progression, PS (>2) and EGFR wild type were risk factors for median PFS. PS (>2) were independent risk factors for MST. 4. Adverse reactions: The most common adverse reactions of EGFR-TKI combined with anti-angiogenesis therapy in patients with advanced NSCLC were rash, anorexia and so on. Secondary administration of EGFR-TKI combined with anti-angiogenesis therapy is effective and safe. EGFR gene mutation is a favorable factor affecting the therapeutic efficacy. 2. Secondary administration of EGFR-TKI combined with anti-angiogenesis therapy predicts survival of advanced NSCLC mPFS: 6 months, MST: 10 months. Distant metastasis before treatment, staging, EGFR, PS score, efficacy and COX multivariate regression indicated distant metastasis, disease progression, PS (>2), and EGFR wild type were risk factors for median PFS. PS (>2) score was an independent risk factor for MST.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2
本文編號(hào)：2194453
[Abstract]:OBJECTIVE: Drug resistance in patients with advanced NSCLC is inevitable after EGFR-TKI treatment. Delaying EGFR-TKI resistance has become a hot topic in recent years. The purpose of this study was to investigate the clinical efficacy, prognostic factors and adverse reactions of EGFR-TKI combined with antiangiogenic drugs in the treatment of advanced NSCLC. Patients with advanced NSCLC who were diagnosed by histopathology in the respiratory ward of Shanxi Cancer Hospital from January 1, 2010 to February 1, 2017 were treated with EGFR-TKI in the past. After a period of benefit, the patients developed disease progression and continued to receive EGFR-TKI secondary treatment and combined with anti-angiogenesis drugs. The clinical characteristics, curative effect and survival analysis of all the patients in this study were analyzed by SPSS. The clinical factors affecting the efficacy of the patients were analyzed by X2 test. Results: 1. Clinical features: The overall age distribution of 40 patients with advanced NSCLC ranged from 42 to 71 years old, including 20 males and 20 females. The ECOG score was 0-1. Thirty patients were diagnosed as having no history of smoking, 17 as having a history of smoking, 17 as having a history of smoking, and 17 as having a history of smoking. 23 patients with distant metastasis and 17 patients without distant metastasis were treated with EGFR-TKI combined with anti-angiogenesis therapy. 17 cases, PD: 14 cases, ORR 22.5% (9/40), DCR 65% (26/40). The DCR of EGFR gene mutation patients was significantly higher than that of EGFR negative patients (P 0.05). Stage IIIB, EGFR gene mutation, PS 0-1, disease control patients with median PFS significantly better than before treatment, stage IV, EGFR wild type, PS score (> 2), disease progression (P 0.05). EGFR mutation, disease control, PS score 0-1 in patients with MST than EGFR wild type, disease progression, PS score (> 2) multivariate regression showed that. Before treatment, distant metastasis, disease progression, PS (>2) and EGFR wild type were risk factors for median PFS. PS (>2) were independent risk factors for MST. 4. Adverse reactions: The most common adverse reactions of EGFR-TKI combined with anti-angiogenesis therapy in patients with advanced NSCLC were rash, anorexia and so on. Secondary administration of EGFR-TKI combined with anti-angiogenesis therapy is effective and safe. EGFR gene mutation is a favorable factor affecting the therapeutic efficacy. 2. Secondary administration of EGFR-TKI combined with anti-angiogenesis therapy predicts survival of advanced NSCLC mPFS: 6 months, MST: 10 months. Distant metastasis before treatment, staging, EGFR, PS score, efficacy and COX multivariate regression indicated distant metastasis, disease progression, PS (>2), and EGFR wild type were risk factors for median PFS. PS (>2) score was an independent risk factor for MST.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 楊龍海;葉波;魏星;劉向陽;;最新國際肺癌TNM分期標(biāo)準(zhǔn)(第8版)修訂稿解讀[J];中國醫(yī)刊;2016年09期
，本文編號(hào)：2194453
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