EGFR-TKI二次给药联合抗血管生成药物治疗晚期NSCLC的临床疗效观察
发布时间：2018-08-20 17:38
【摘要】：目的:晚期NSCLC患者经EGFR-TKI治疗出现耐药现象不可避免,延缓EGFR-TKI耐药成为近年来热门话题,本研究旨在探讨EGFR-TKI二次给药联合抗血管生成药物治疗晚期NSCLC的临床疗效,预后影响因素及不良反应。方法:依据入组标准及排除标准选取2010年1月1日至2017年2月1日就诊于山西省肿瘤医院呼吸二病区的病理组织学确诊的晚期NSCLC患者,患者既往都接受过EGFR-TKI治疗,获益一段时间后出现疾病进展,继续接受EGFR-TKI二次用药并且联合抗血管生成药物治疗。收集患者完整临床资料并进行回顾性的临床分析,患者的疗效评价严格按照实体瘤疗效评价标准(RECIST)进行评价。并对本研究中全组患者的临床特征及疗效、生存分析进行统计分析,均采用SPSS统计学方法分析:其中影响患者疗效的临床因素使用X2检验及Fisher精确概率法,用Kaplan-Meier法进行生存分析,使用Log-rank时序检验进行预后单因素分析,使用COX回归模型进行多因素分析。结果:1.临床特征:本研究40例晚期NSCLC患者总体年龄分布范围在42-71岁,其中男性20人,女性20人。ECOG评分为0-1分者30例,≥2分者10人。无吸烟史者23例,有吸烟史者17例。临床分期IIIB期17人,IV期23人。4 0例患者使用靶向药物EGFR-TKI:吉非替尼13例,厄洛替尼20例,埃克替尼7例。病理类型均为腺癌。患者治疗过程中发现EGFR基因突变患者26例,野生型8例,未知6例。联合治疗前有远处转移的患者23例,无远处转移的患者17例。治疗时机:EGFR-TKI联合抗血管生成治疗二线使用者有7例,三线及以上使用的者33例。2.疗效:40例晚期NSCLC患者接受EGFR-TKI二次给药联合抗血管生成治疗后,疗效评价,CR:0例,PR:9例,SD:17例,PD:14例,ORR为22.5%(9/40),DCR为65%(26/40)。其中EGFR基因突变患者DCR明显高于EGFR阴性的患者(P0.05)。3.预后:生存分析结果显示:本研究患者中位无进展生存期mPFS:6个月,中位总生存期MST:10个月;单因素Log-rank时序检验提示治疗前无远处转移、分期IIIB期、EGFR基因突变、PS 0-1分、疾病控制者其中位PFS明显优于治疗前有远处转移、分期IV期、EGFR野生型、PS评分≥2分、疾病进展者(P0.05)。EGFR突变、疾病控制、PS评分0-1分患者的MST优于EGFR野生型、疾病进展、PS评分≥2分患者。COX多因素回归显示治疗前有远处转移、疾病进展、PS≥2分、EGFR野生型为影响中位PFS的危险因素。PS≥2分是影响MST的独立危险因素。4.不良反应:EGFR-TKI联合抗血管生成治疗晚期NSCLC患者最常见的不良反应为皮疹、厌食等。结论:1.晚期非小细胞肺癌EGFR-TKI耐药现象出现后接受EGFR-TKI二次用药联合抗血管生成治疗疗效显著、安全。EGFR基因突变是影响治疗疗效的有利因素。2.EGFR-TKI二次给药联合抗血管生成治疗晚期NSCLC预测生存期mPFS:6个月,MST:10个月。治疗前远处转移情况、分期、EGFR、PS评分、疗效与预后有相关性。COX多因素回归提示治疗前有远处转移、疾病进展、PS≥2分、EGFR野生型为影响中位PFS的危险因素。PS≥2分评分是影响患者MST的独立危险因素。
[Abstract]:OBJECTIVE: Drug resistance in patients with advanced NSCLC is inevitable after EGFR-TKI treatment. Delaying EGFR-TKI resistance has become a hot topic in recent years. The purpose of this study was to investigate the clinical efficacy, prognostic factors and adverse reactions of EGFR-TKI combined with antiangiogenic drugs in the treatment of advanced NSCLC. Patients with advanced NSCLC who were diagnosed by histopathology in the respiratory ward of Shanxi Cancer Hospital from January 1, 2010 to February 1, 2017 were treated with EGFR-TKI in the past. After a period of benefit, the patients developed disease progression and continued to receive EGFR-TKI secondary treatment and combined with anti-angiogenesis drugs. The clinical characteristics, curative effect and survival analysis of all the patients in this study were analyzed by SPSS. The clinical factors affecting the efficacy of the patients were analyzed by X2 test. Results: 1. Clinical features: The overall age distribution of 40 patients with advanced NSCLC ranged from 42 to 71 years old, including 20 males and 20 females. The ECOG score was 0-1. Thirty patients were diagnosed as having no history of smoking, 17 as having a history of smoking, 17 as having a history of smoking, and 17 as having a history of smoking. 23 patients with distant metastasis and 17 patients without distant metastasis were treated with EGFR-TKI combined with anti-angiogenesis therapy. 17 cases, PD: 14 cases, ORR 22.5% (9/40), DCR 65% (26/40). The DCR of EGFR gene mutation patients was significantly higher than that of EGFR negative patients (P 0.05). Stage IIIB, EGFR gene mutation, PS 0-1, disease control patients with median PFS significantly better than before treatment, stage IV, EGFR wild type, PS score (> 2), disease progression (P 0.05). EGFR mutation, disease control, PS score 0-1 in patients with MST than EGFR wild type, disease progression, PS score (> 2) multivariate regression showed that. Before treatment, distant metastasis, disease progression, PS (>2) and EGFR wild type were risk factors for median PFS. PS (>2) were independent risk factors for MST. 4. Adverse reactions: The most common adverse reactions of EGFR-TKI combined with anti-angiogenesis therapy in patients with advanced NSCLC were rash, anorexia and so on. Secondary administration of EGFR-TKI combined with anti-angiogenesis therapy is effective and safe. EGFR gene mutation is a favorable factor affecting the therapeutic efficacy. 2. Secondary administration of EGFR-TKI combined with anti-angiogenesis therapy predicts survival of advanced NSCLC mPFS: 6 months, MST: 10 months. Distant metastasis before treatment, staging, EGFR, PS score, efficacy and COX multivariate regression indicated distant metastasis, disease progression, PS (>2), and EGFR wild type were risk factors for median PFS. PS (>2) score was an independent risk factor for MST.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
本文编号：2194453
[Abstract]:OBJECTIVE: Drug resistance in patients with advanced NSCLC is inevitable after EGFR-TKI treatment. Delaying EGFR-TKI resistance has become a hot topic in recent years. The purpose of this study was to investigate the clinical efficacy, prognostic factors and adverse reactions of EGFR-TKI combined with antiangiogenic drugs in the treatment of advanced NSCLC. Patients with advanced NSCLC who were diagnosed by histopathology in the respiratory ward of Shanxi Cancer Hospital from January 1, 2010 to February 1, 2017 were treated with EGFR-TKI in the past. After a period of benefit, the patients developed disease progression and continued to receive EGFR-TKI secondary treatment and combined with anti-angiogenesis drugs. The clinical characteristics, curative effect and survival analysis of all the patients in this study were analyzed by SPSS. The clinical factors affecting the efficacy of the patients were analyzed by X2 test. Results: 1. Clinical features: The overall age distribution of 40 patients with advanced NSCLC ranged from 42 to 71 years old, including 20 males and 20 females. The ECOG score was 0-1. Thirty patients were diagnosed as having no history of smoking, 17 as having a history of smoking, 17 as having a history of smoking, and 17 as having a history of smoking. 23 patients with distant metastasis and 17 patients without distant metastasis were treated with EGFR-TKI combined with anti-angiogenesis therapy. 17 cases, PD: 14 cases, ORR 22.5% (9/40), DCR 65% (26/40). The DCR of EGFR gene mutation patients was significantly higher than that of EGFR negative patients (P 0.05). Stage IIIB, EGFR gene mutation, PS 0-1, disease control patients with median PFS significantly better than before treatment, stage IV, EGFR wild type, PS score (> 2), disease progression (P 0.05). EGFR mutation, disease control, PS score 0-1 in patients with MST than EGFR wild type, disease progression, PS score (> 2) multivariate regression showed that. Before treatment, distant metastasis, disease progression, PS (>2) and EGFR wild type were risk factors for median PFS. PS (>2) were independent risk factors for MST. 4. Adverse reactions: The most common adverse reactions of EGFR-TKI combined with anti-angiogenesis therapy in patients with advanced NSCLC were rash, anorexia and so on. Secondary administration of EGFR-TKI combined with anti-angiogenesis therapy is effective and safe. EGFR gene mutation is a favorable factor affecting the therapeutic efficacy. 2. Secondary administration of EGFR-TKI combined with anti-angiogenesis therapy predicts survival of advanced NSCLC mPFS: 6 months, MST: 10 months. Distant metastasis before treatment, staging, EGFR, PS score, efficacy and COX multivariate regression indicated distant metastasis, disease progression, PS (>2), and EGFR wild type were risk factors for median PFS. PS (>2) score was an independent risk factor for MST.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
【参考文献】
相关期刊论文 前1条
1 杨龙海;叶波;魏星;刘向阳;;最新国际肺癌TNM分期标准(第8版)修订稿解读[J];中国医刊;2016年09期
，本文编号：2194453
本文链接：https://www.wllwen.com/yixuelunwen/zlx/2194453.html
