吉非替尼针对不同基因突变的靶向治疗在非小细胞肺癌中的疗效观察

摘要

Objective: To investigate the clinical effect of Iressa for NSCLC , and observe the change of EGFR , HER2, CEA, CYFRA21-1, NSE, pro-GRP before and after treatment. Methods:Patients with NSCLC were divided into four groups according to sequencing results. Patients in group one were the EGFR and HER2 mutation simultaneously , and patients in group two were the EGFR mutation , and patients in group three were the HER2 mutation, and patients in group four were not mutation for EGFR and HER2. Evaluation of EGFR, HER2, CEA, CYFRA21-1, NSE,PROGRP before and after treatment were recorded respectively. The expression of biotin peroxidase (SP) to detect EGFR and HER2 in the organization before and after treatment were compared. Results:The concentration of EGFR and HER2 in group one , group two and group three after treatment were depressed than those before treatment (P<0.05). The concentration of EGFR and HER2 of group one is more apparent depressed than that those in other group. There was not statistical significance about the concentration of EGFR and HER2 in group four (P>0.05). The concentration of CEA, CYFRA21-1, NSE,PROGRP in group one, group two and group three after treatment were depressed than those before treatment (P<0.05). There was not statistical significance about the concentration of CEA, CYFRA21-1, NSE,PROGRP in group four(P>0.05). Conclusion: Gifitinib could improve the clinical effect for NSCLC of EGFR and HER2 mutation simultaneously.%目的：探讨吉非替尼治疗不同基因表达的 NSCLC 患者的临床疗效，并观察治疗前后患者血清中EGFR、HER2以及癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA 21－1）、神经特异性烯醇化酶（ NSE ）、促胃酸激素释放肽前体（pro－GRP）的表达情况。方法：将患者分为4组，A 组为EGFR 基因和HER2基因同时突变，B组为EGFR 基因突变，C 组为HER2基因突变，D 组为无 EGFR 基因和 HER2基因突变。应用吉非替尼分别治疗上述患者，同时检测EGFR、HER2以及CEA、CYFRA21－1及NSE、PROGRP 在治疗前后血清中的含量。同时用生物素原过氧化物酶法（S－P 法）检测EGFR 和HER2在治疗前后组织中的表达量。结果：A 组、B 组和C 组患者血清和组织中 EGFR 和 HER2浓度在治疗后均有不同程度的下降（P＜0．05），D 组患者治疗后血清和组织中 EGFR 和HER2浓度无明显变化（P＞0．05）。A 组患者治疗后血清和组织中EGFR 和HER2浓度下降较其他三组明显，这和患者在治疗后的临床表现相一致，表现为咳嗽减轻、疼痛减轻、病灶减小。 A 组、B 组和 C 组患者血清中 CEA、CYFRA21－1及 NSE、PROGRP 浓度在治疗后均有不同程度的下降（P＜0．05），D 组患者治疗后血清中 CEA、CYFRA21－1及NSE、PROGRP 浓度无明显变化（P＞0．05）。结论：应用吉非替尼对于有EGFR 和HER2基因同时突变的患者，效果要优于单个基因突变的患者。