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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2017, Vol. 10 ›› Issue (01) : 20 -24. doi: 10.3877/cma.j.issn.1674-6902.2017.01.005

所属专题： 总编推荐； 文献；

论著

EGFR基因21外显子L858R突变肺腺癌患者化疗和靶向治疗疗效的回顾性分析
罗萌1, 徐瑜2, 胡义德1,†()   
  1. 1. 400037　重庆，第三军医大学新桥医院肿瘤科·全军肿瘤研究所
    2. 400037　重庆，第三军医大学新桥医院全军呼吸研究所
  • 收稿日期:2016-08-25 出版日期:2017-02-25
  • 通信作者: 胡义德
  • 基金资助:
    国家自然科学基金资助项目(81372340)

Retrospective study on the differences of efficacy of chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor treatment in advanced lung adenocarcinoma patients harboring L858R mutation

Meng Luo1, Yu Xu2, Yide Hu1,†()   

  1. 1. Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
    2. Institute of Breath, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
  • Received:2016-08-25 Published:2017-02-25
  • Corresponding author: Yide Hu
  • About author:
    Corresponding author: Hu Yide, Email:
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罗萌, 徐瑜, 胡义德. EGFR基因21外显子L858R突变肺腺癌患者化疗和靶向治疗疗效的回顾性分析[J]. 中华肺部疾病杂志(电子版), 2017, 10(01): 20-24.

Meng Luo, Yu Xu, Yide Hu. Retrospective study on the differences of efficacy of chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor treatment in advanced lung adenocarcinoma patients harboring L858R mutation[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(01): 20-24.

目的

探讨EGFR基因21外显子L858R突变肺腺癌患者使用化疗和EGFR-TKI靶向治疗疗效的差异。

方法

回顾性分析，收集第三军医大学新桥医院2010年1月至2015年12月间EGFR基因检测为21外显子L858R突变的病例资料完整的ⅢB/Ⅳ期一线接受化疗或EGFR酪氨酸激酶抑制剂(EGFR-TKI)靶向治疗的肺腺癌患者作为研究对象，将患者根据一线治疗方式分为化疗组和靶向治疗组，对两组患者近期疗效(客观缓解率ORR、疾病控制率DCR)及生存期(无进展生存期PFS、总生存期OS)进行回顾性研究。

结果

①共收集符合纳入标准的EGFR基因21外显子L858R突变的肺腺癌患者68例，其中化疗组患者40例(58.8%)，靶向治疗组患者28例(41.2%)，两组患者在性别、年龄、吸烟史、PS评分和临床分期等临床资料基线水平一致(P>0.05)；②化疗和靶向治疗组ORR分别为45.0%和17.9%(P＝0.020)；DCR分别为95.0%和71.4%(P＝0.012)，PFS分别为9.901个月和6.746个月(P＝0.045)；OS分别为21.738个月和23.611个月(P＝0.378)。

结论

与靶向治疗相比，EGFR基因21外显子L858R突变肺腺癌患者化疗治疗在近期疗效及PFS上较有优势，OS未见明显获益。

关键词: EGFR基因突变, 肺腺癌, 化疗, 靶向治疗, 临床疗效, 回顾性分析
Objective

To explore the differences of efficacy of the chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitor treatment in advanced lung adenocarcinoma patients harboring exon 21 mutation.

Methods

The clinical characteristic of advanced lung adenocarcinoma harboring EGFR 21 L858R mutation receiving first-line chemotherapy and EGFR-TKI treatment in Xinqiao hospital from Jan 2010 to Dec 2015 were studied. The differences between the clinical indicators of the two groups, such as objective response rates (ORR), disease control rates(DCR), progression free survival(PFS), overall survival(OS) were analyzed.

Results

①The data of 68 patients were collected including 40 chemotherapy and 28 EGFR-TKI. Baselines of sex, age, smoking status, ECOG PS between the two groups were consistent (P>0.05) . ②The ORR of the two groups were 45% and 17.9%(P=0.020), the DCR of the two groups were 95% and 71.4%(P=0.012). The PFS of the two groups were 9.901 and 6.746 months (P=0.045), the OS of the two groups were 21.738 and 23.611 months (P=0.378).

Conclusions

Compared with EGFR-TKI, the patients of advanced lung adenocarcinoma treated with chemotherapy had significant advantage of ORR, DCR and PFS, no difference on OS.

Key words: Epidermal growth factor receptor mutation, Lung adenocarcinoma, Chemotherapy, Targeted molecular therapy, Clinical efficacy, Retrospective analysis
表1 两组患者基本临床资料(例)
临床资料 化疗(n＝40) 靶向治疗(n＝28) P值
性别 ? ? ?
? 男 20 17 0.383
? 女 20 11 ?
年龄 ? ? ?
? ≤58岁 24 13 0.269
? ≥58岁 16 15 ?
吸烟史 ? ? ?
? 有 15 8 0.444
? 无 25 20 ?
ECOG PS ? ? ?
? 0分 5 3 0.228
? 1分 35 23 ?
? 2分 0 2 ?
临床分期 ? ? ?
? ⅢB期 2 3 0.396
? Ⅳ期 38 25 ?
表2 L858R突变患者化疗及靶向治疗疗效比较[n(%)]
治疗方式 治疗效果 客观缓解率 疾病控制率
PR SD PD 合计
化疗 18 20 2 40 45.00 95.00
靶向治疗 5 15 8 28 17.86 71.43
P值 ? ? ? 0.020 0.012 ?
图1 L858R突变患者化疗及靶向治疗无进展生存期曲线
图2 L858R突变患者化疗及靶向治疗总生存期曲线
1
钱桂生. 肺癌不同病理类型发病率的变化情况及其原因[J/CD]. 中华肺部疾病杂志(电子版), 2011, 4(1): 1-5.
2
Jemal A, Bray F, Center MM, et al. Global cancer statistics[J]. CA Cancer J Clin, 2011, 61(2): 69-90.
3
Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008[J]. Int J Cancer, 2010, 127(12): 2893-2917.
4
2015美国国家综合癌症网络(NCCN)指南：肺癌的全身治疗[J]．中国全科医学，2015(18): 2126.
5
Gridelli C, Ardizzoni A, Douillard JY, et al. Recent issues in first-line treatment of advanced non-small-cell lung cancer: Results of an international expert panel meeting of the Italian association of thoracic oncology[J]. Lung cancer, 68(3): 319-331.
6
Kuan FC, Kuo LT, Chen MC, et al. Overall survival benefits of first-line EGFR tyrosine kinase inhibitors in EGFR-mutated non-small-cell lung cancers: a systematic review and meta-analysis[J]. Br J Cancer, 2015, 113(10): 1519-1528.
7
Rosell R, Moran T, Queralt C, et al. Screening for epidermal growth factor receptor mutations in lung cancer[J]. N Engl J Med, 2009, 361(10): 958-967.
8
Yang JC, Wu YL, Schuler M, et al. Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials[J]. Lancet Oncol, 2015, 16(2): 141-151.
9
Jackman DM, Yeap BY, Sequist LV, et al. Exon 19 deletion mutations of epidermal growth factor receptor are associated with prolonged survival in non-small cell lung cancer patients treated with gefitinib or erlotinib[J]. Clin Cancer Res, 2006, 12(13): 3908-3914.
10
Travis WD, Brambilla E, Muller-Hermelink HK, et al. World Health Organization classification of tumours. Pathology and genetics of tumours of the lung pleurthymus and heart[M]. Lyon: IARC Press, 2004.
11
钱桂生. 为提高我国呼吸系统疾病的诊治水平而努力[J/CD]. 中华肺部疾病杂志(电子版), 2012, 5(1): 1-3.
12
邹晶，徐兴祥，王大新，等. 肺癌放化疗"实时"疗效评估方法的研究进展[J/CD]. 中华肺部疾病杂志(电子版), 2013, 6(4): 360-363.
13
Zhang Y, Sheng J, Kang S, et al. Patients with exon 19 deletion were associated with longer progression-free survival compared to those with L858R mutation after first-line EGFR-TKIs for advanced non-small cell lung cancer: a meta-analysis[J]. PLoS One, 2014, 9(9): e107161.
14
Gazdar AF, Shigematsu H, Herz J, et al. Mutations and addiction to EGFR: The achilles 'heal’ of lung cancers[J]. Trends Mol Med, 2004, 10(10): 481-486.
15
Yu HA, Arcila ME, Hellmann MD, et al. Poor response to erlotinib in patients with tumors containing baselineEGFR T790M mutations found by routine clinical molecular testing[J]. Ann Oncol, 2014, 25(2): 423-428.
16
Chou TY, Chiu CH, Li LH, et al. Mutation in the tyrosine kinase domain of epidermal growth factor receptor is a predictive and prognostic factor for gefitinib treatment in patients with non-small cell lung cancer[J]. Clin Cancer Res, 2005, 11(10): 3750-3757.
17
Mitsudomi T, Yatabe Y. Mutations of the epidermal growth factor receptor gene and related genes as determinants of epidermal growth factor receptor tyrosine kinase inhibitors sensitivity in lung cancer[J]. Cancer Sci, 2007, 98(12): 1817-1824.
18
Wu JY, Wu SG, Yang CH, et al. Lung cancer with epidermal growth factor receptor exon 20 mutations is associated with poor gefitinib treatment response[J]. Clin Cancer Res, 2008, 14(15): 4877-4882.
19
Arrieta O, Cardona AF, Corrales L, et al. The impact of common and rare EGFR mutations in response to EGFR tyrosine kinase inhibitors and platinum-based chemotherapy in patients with non-small cell lung cancer[J]. Lung Cancer, 2015, 87(2): 169-175.
20
Ellis PM, Coakley N, Feld R, et al. Use of the epidermal growth factor receptor inhibitors gefitinib, erlotinib, afatinib, dacomitinib, and icotinib in the treatment of non-small-cell lung cancer: a systematic review[J]．Curr Oncol, 2015, 22(3): 183-215.
21
Shi L, Tang J, Tong L, et al. Risk of interstitial lung disease with gefitinib and erlotinib in advanced non-small cell lung cancer: a systematic review and meta-analysis of clinical trials[J]. Lung Cancer, 2014, 83(2): 231-239.
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