吉非替尼一线与二线治疗E GF R突变型晚期非小细胞肺癌的疗效比较

摘要

目的：观察吉非替尼用于表皮生长因子受体（epidermal growth factor receptor，EGFR）突变型晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）一线或二线治疗对患者近期疗效及生存期的影响，分析吉非替尼的最佳治疗时机。方法：回顾性分析61例EGFR突变型（外显子19或21突变）晚期NSCLC患者的病历和随访资料，其中31例患者接受吉非替尼一线治疗，30例患者接受吉非替尼二线治疗；应用Kaplan-meier法进行生存分析。结果：两组患者的性别（P＝0．717）、年龄（P＝0．849）、吸烟史（P＝0．173）、病理类型（P＝0．573）和临床分期（P＝0．668）的差异无统计学意义。吉非替尼一线较二线治疗EGFR突变型NSCLC的近期有效率及疾病控制率明显提高（RR：64．5％ vs 23．3％，P＝0．001；DCR：87．1％ vs 60．0％，P＝0．016）。吉非替尼一线和二线治疗的中位无进展生存期分别为7．6和6．4个月（P＝0．392），中位总生存期分别为16．0和17．6个月（P＝0．606）。另外，在最终获得疾病控制的患者中，吉非替尼一线治疗组为27例，二线治疗组为18例，2组中位无进展生存期及总生存期也无明显差异（PFS：8．0 vs 9．7个月，P＝0．777；OS：17．0 vs 20．0个月，P＝0．196）。结论：吉非替尼用于EGFR突变型晚期NSCLC患者，一线较二线治疗的近期疗效明显提高，但生存获益无明显差异。%Objective:To evaluate the efficacy and survival of gefitinib as first-line therapy and second-line therapy in advanced EGFR mutated NSCLC and analyze the best timing of gefitinib treatment.Methods:Medical re-cords and follow-up information of61 patients with EGFR mutated(Exon19 or 21)advanced NSCLC were retrospec-tively reviewed.Thirty-one patients were treated with gefitinib as first-line therapy,and 30 were treated with ge-fitinib as second-line therapy.Survival analysis was evaluated by using Kaplan -meier method.Results:The two groups were comparable in gender(P=0.717),age(P=0.849),smoking history (P=0.173),pathology(P=0.573)and clinical stage(P=0.668).The response rates and disease control rates in the first-line therapy was significantly higher than the second-line therapy(RR:64.5% vs 23.3%,P=0.001;DCR:87.1% vs 60.0%,P=0.016).The median progression -free survival in the two groups were 7.6 and 6.4 months,respectively (P=0.392).The median overall survivals in the two groups were 16.0 and 17.6 months(P=0.606).The median pro-gression-free survival and median overall survival of patients with disease control in the first-line therapy group was similar to that of the second-line therapy group(PFS:8.0 vs 9.7 months,P=0.777;OS:17.0 vs 20.0 months,P=0.196).Conclusion:To EGFR mutated advanced NSCLC the efficacy of gefitinib treatments was significantly higher in first-line therapy than in second-line therapy,however the survival was similar between two groups.