厄洛替尼治疗动脉灌注化疗后进展的肺腺癌脑转移的临床分析

摘要

目的 观察厄洛替尼治疗动脉灌注化疗后进展的肺腺癌脑转移患者的疗效及安全性.方法 2008年11月至2011年1月,20例初治的肺腺癌脑转移患者接受动脉灌注化疗,化疗药物为替尼泊苷、尼莫司汀、吉西他滨、卞铂等,每4周治疗1次,直至颅内病灶进展,停止动脉灌注化疗,行厄洛替尼150 mg/d治疗,直至疾病进展或发生不可耐受性药物不良反应,评价缓解率、无进展生存时间(PFS)、总生存期(OS)及药物不良反应.结果 20例患者均接受2次以上动脉灌注化疗,中位治疗次数3次.20例患者均可进行厄洛替尼治疗近期疗效评价,治疗总有效率(ORR)为75％(15/20),疾病控制率(DCR)为90％( 18/20).中位PFS为9个月[95％可信区间(CI)为7.65～10.35个月],中位总生存期15个月(95％ CI为11.48～ 18.53个月),6个月生存率90％(18/20),1年生存率为75％(15/20).厄洛替尼最常见的不良反应是皮疹和腹泻,发生率分别为90％( 18/20)和75％ (15/20),不良反应多为1～2级,3～4级不良反应发生率仅为10％(2/20).结论 厄洛替尼二线治疗肺腺癌脑转移的疗效确切,患者耐受性良好,可作为动脉灌注化疗失败后肺腺癌脑转移的治疗选择.%Objective To explore the clinical efficacy and the adverse effects of erlotinib, used as a 2nd-line treatment, in treating lung adenocarcinoma complicated by brain metastases after the failure of arterial infusion chemotherapy. Methods During the period from November 2008 to January 2011, a total of 20 cases with lung adenocarcinoma complicated by brain metastases received arterial infusion chemotherapy. This procedure was performed once every 4 weeks until the intracranial lesions became worse or intolerable toxicity emerged. Then erlotinib was employed as a 2nd-line treatment in all the patients. The dose of erlotinib was 150 mg/day, and the treatment was kept on till the diseases deteriorated or intolerable adverse effects occurred. The remission rate, progression free survival time, overall survival time and the adverse effects of erlotinib were evaluated. Results All the 20 patients received arterial infusion chemotherapy for at least 2 times, the median treatment times was 3 times. For the 20 cases receiving erlotinib treatment, the overall response rate (CR + PR) was 75% (15/20) and the disease control rate (CR + PR + SD) was 90% (18/20). The median progression free survival time was 9 months with the 95% CI being (7.65 - 10.35) months. The Overall median survival time was 15 months and the 95% CI was (11.48 - 18.53) months. The 6-month survival rate and one-year survival rate were 90% and 75% respectively. The most common adverse effects of erlotinib were skin rash (90%, 18/20) and diarrhea (75%, 15/20). Most adverse effects were of grade Ⅰ-Ⅱ, and only 10% (2/20) of patients got adverse effects of≥3grade. Conclusion As a 2nd-line treatment for lung adenocarcinoma with brain metastases, erlotinib is veryeffective and tolerable. Therefore, erlotinih can be employed as a therapeutic option for the patients who has failed to respond to the arterial infusion chemotherapy.