EGFR突变阳性的晚期非小细胞肺癌交替使用EGFR-TKI及放化疗的回顾性研究

摘要

Objective: To retrospectively observe the clinical efficacy and adverse effects of two sequential therapeutic modes, chemoradiotherapy-EGFR-TKI-chemoradiotherapy ( RCT-TKI-RCT) and EGFR-TKI-chemoradiotherapy-EGFR-TKI ( TKI-RCT-TKI), in advanced non-small cell lung cancer (NSCLC) patients with positive EGFR gene mutation. Methods:The information of 46 advanced NSCLC patients with positive EGFR gene mutation were collected. Twenty-six patients were treated with RCT-TKI-RCT and 20 patients with TKI-RCT-TKI. The patients in both groups were followed by second-line treatment after their first-line treatment failed, and their pro-gression-free survivals (PFS) 1 were recorded. After failure of second-line treatment, third-line treatment was performed and PFS2 was obtained. All patients were followed up until they died, and overall survival ( OS) of them was obtained. PFS1, PFS2, OS and adverse effects of both group were evaluated. Results: There were no statistically significant differences be-tween the two groups in clinical features, including age, KPS, history of tobacco use, EGFR mutation status and initial me-tastasis site. The median PFS1 of patients in the TKI-RCT-TKI group was longer than that of patients in the RCT-TKI-RCT group. The difference is not statistically significant (6. 6 months vs 5. 3 months, P=0. 077). The median PFS2 of the for-mer was also longer than that of the latter. The difference was not statistically significant (6. 3 months vs 5. 0 months, P=0. 646). There was also no statistically significant difference in median OS between the TKI-RCT-TKI group and the RCT-TKI-RCT group (21. 3 months vs 21. 0 months, P=0. 506). The adverse effects of the TKI-RCT-TKI group were relatively slighter, but there were no statistically significant differences between the two groups in diarrhea, rash, hematotoxicity ofⅢ~Ⅳ degree, nausea and vomiting etc. Conclusion: PFS1, PFS2 and OS of the TKI-RCT-TKI group were longer than those of the RCT-TKI-RCT group, and the adverse effects of the former were slighter.%目的: 对EGFR基因敏感性突变的晚期非小细胞肺癌患者分别序贯进行放化疗-靶向-放化疗和靶向-放化疗-靶向治疗,回顾性地观察两种综合治疗模式的临床疗效及治疗相关副作用.方法:共收集携带EGFR基因敏感性突变的晚期非小细胞肺癌患者病例资料46份:26例患者接受放化疗-靶向-放化疗模式,20例患者接受靶向-放化疗-靶向治疗模式.两组患者在各自的一线治疗失败后都序贯进行二线治疗,获取患者的无疾病进展生存期1( progres-sion-free survival 1,PFS1);二线治疗失败后序贯三线治疗,获取PFS2;三线治疗后最终随访至患者死亡,得出总生存期(overall survival,OS).比较两组治疗模式的PFS1、PFS2、OS及治疗相关副作用.结果:两组患者在年龄、KPS、吸烟状况、EGFR突变状态、初始转移部位等临床特征上无显着性差异.接受靶向-放化疗-靶向治疗患者组的中位PFS1长于放化疗-靶向-放化疗组,差异无统计学意义(6. 6个月 vs 5. 3个月,P=0. 077);前者的中位PFS2也稍长于后者,但差异无统计学意义(6. 3 个月 vs 5. 0 个月,P=0. 646).中位 OS方面,两组患者的差异也无统计学意义(21. 3个月 vs 21. 0个月,P=0. 506).靶向-放化疗-靶向组治疗发生治疗相关副作用相对较轻,但两组间腹泻、皮疹和Ⅲ~Ⅳ度骨髓抑制、恶心呕吐等副作用的差异均无统计学意义.结论:靶向-放化疗-靶向序贯治疗模式组的PFS1、PFS2和OS均具有优于放化疗-靶向-放化疗模式组的趋势,且治疗相关副作用也具有较轻的趋势.