易瑞沙用于肺腺癌患者的一线治疗与化疗失败后治疗的疗效比较

摘要

Objective:To compare the curative effect of Iressa in patients with pulmonary adenocarcinoma used as primary treatment and after the failure of previous chemotherapy.Observe the side effects and tolerability.Methods:Total of 53 patients with pulmonary adenocarcinoma were involved,including 30 patients receive Iressa as the primary treatment and 23 patients after the failure of previous platinum based chemotherapy.The following symptom improvement and side effects start as soon as the beginning treatment with Iressa 250mg once daily were observed.The treatment continued 10 days after the failure of first 30 days treatment,then stop the treatment if it was still no curative effect or until the patient's maximal tolerance.The treatment was ceased until the disease progression.Results:The symptom improvement was seen after 2-30 days,mean was 7.7 days after Iressa treatment.Every patient showed side effects with grade Ⅰ-Ⅱ and the most common side effects were diarrhea,rash,dryness,desquamation.And one patient was encountered interstitial lung disease.Of 53 patients,CR was 3.77％,PR 50.94％,SD 28.30％,disease control rate 83.0％ and median effective time was 7.5 months.CR was 3.33％,PR 63.33％,SD 26.67％,and DCR 93.3％ in the patients with Iressa as the primary treatment and CR was 4.35％,PR 34.78％,SD 30.43％,and disease control rate 69.6％ in the patients with the failure of previous chemotherapy.There was no statistical difference between the two groups (P =0.055).The disease control rate in women was 96％,and in men 71.4％ (P =0.044).Conclusion:Iressa is safe and effective in the treatment of pulmonary adenocarcinaoma.There is no difference between primary Iressa treatment and Iressa treatment after failure of previous chemotherapy,but Iressa is more effective in women than in men.%目的:比较易瑞沙作为肺腺癌一线治疗方案和化疗进展后治疗方案的疗效,观察易瑞沙不良反应及耐受性.方法:收集病理明确诊断的肺腺癌病例53例,其中既往未接受化疗患者30例,既往接受以铂类为主的联合方案化疗后疾病进展患者23例.易瑞沙用法250mg/日,顿服.服药即开始随访症状改善、不良反应出现的时间及严重程度,定期复查,评价疗效.持续观察30天,如果没有症状改善而疾病进展则再服用10天,仍无效停药；疾病控制则持续服药至疾病进展或出现严重不良反应不能耐受.结果:易瑞沙起效时间从2天到30天不等,平均7.7天.53例患者中均有不同程度的不良反应出现,多为Ⅰ-Ⅱ级,以痤疮样皮疹、腹泻、皮肤干燥、脱屑最为常见；发现1例间质性肺纤维化.53例患者CR 3.77％,PR 50.94％,SD 28.30％,DCR 83.0％,中位有效时间7.5个月.其中,一线治疗组CR 3.33％,PR 63.33％,SD 26.67％,DCR 93.3％,化疗失败组CR 4.35％,PR 34.78％,SD 30.43％,DCR 69.6％,两组疾病控制率无明显差异(P=0.055).疾病控制率在女性为96％,男性为71.4％,两者相比有统计学差异(P=0.044),两组无进展生存期无明显差异(P＞0.05).结论:易瑞沙治疗肺腺癌安全有效,患者不良反应耐受性及依从性好.化疗不影响易瑞沙的疗效.女性肺腺癌比男性肺腺癌患者接受易瑞沙治疗获益更多.