间插治疗模式在EGFR-TKI一线治疗继发性耐药后的晚期NSCLC中疗效观察

摘要

Objective:To investigate the clinical effect of intercalated combination of chemotherapy for advanced non-small cell lung cancer (NSCLC) patients with secondary drug resistance to epidermal growth factor receptor-tyrosine kinasas inhibitors ( EGFR-TKI)therapy. Methods:To retrospectively collect the clinical data of 103 advanced NSCLC patients who received EGFR-TKI as the first-line therapy. Fifty-two patients with intercalated combination of pemetrexed and TKI were enrolled as the intercalated combination group. Another 51 patients with chemotherapy only were included as the chemotherapy group. The primary outcomes were short-term effect,progression-free survival (PFS) and overall survival (OS). Analysis of e EGFR-T790M mutation was performed in some pa-tients,and those patients were subdivided into mutation-positive group and mutation-negative group,for the further analysis of PFS and OS. Results:All patients were valid for the analysis of short-term effect,PFS and OS. Patients in the intercalated combination group had a higher disease control rate (DCR),longer PFS and longer OS compared with those in the chemotherapy group (P＜0. 05,P＜0. 01). In those with EGFR-T790M mutation-negative,patients with intercalated combination of chemotherapy gained higher DCR and longer OS compared with those with chemotherapy only (P＜0. 05). Conclusion:It is possible to carry out individualized second-line chemo-therapy for advanced NSCLC patients with secondary drug resistance to EGFR-TKI. For EGFR-T790M mutation-negative patients,the intercalated combination of pemetrexed and TKI,with a good tolerance and reversing TKI resistance,is more effective compared with chemotherapy only.%目的:探讨晚期非小细胞肺癌(NSCLC)患者在表皮生长因子受体酪氨酸激酶抑制剂( EGFR-TKI)一线治疗继发性耐药后,间插治疗模式对患者疗效及生存期的影响.方法: 回顾性分析103例接受EGFR-TKI一线治疗的晚期NSCLC患者,分为培美曲塞化疗间插TKI治疗组(间插治疗组)52例及单纯化疗组(化疗组)51例,分析两组近期疗效及无进展生存期(PFS)和总生存期(OS).部分患者在EGFR-TKI耐药后进行外周血T790M突变检测,根据检测结果分为T790M突变阳性和阴性亚组,进一步分析其近期疗效及PFS、OS.结果: 所有患者均可评价一线EGFR-TKI治疗进展后二线治疗的近期疗效及PFS、OS.间插治疗组疾病控制率(DCR)、中位PFS、中位OS显著高于化疗组(P＜0. 05,P＜0. 01).在一线EGFR-TKI治疗进展后接受外周血 T790M 突变检测结果为阴性患者中,间插治疗组 DCR 和 OS 显著优于化疗组(P ＜0. 05).结论: 晚期NSCLC患者EGFR-TKI一线治疗继发性耐药后应该采取个体化的二线治疗策略,此类患者提倡进行T790M突变等耐药基因检测;若T790M突变阴性,给予培美曲塞化疗并间插TKI治疗,疗效优于单纯化疗且耐受性良好,并可能逆转TKI耐药.