序贯培美曲赛与联合阿帕替尼治疗EGFR-TKI获得性耐药晚期NSCLC的疗效比较
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摘要
目的对比序贯培美曲塞与联合阿帕替尼治疗EGFR-TKI获得性耐药晚期非小细胞肺癌的疗效。方法选取EGFR-TKI治疗后进展的晚期非小细胞肺癌74例病历资料进行回顾性研究,其中化疗组26例、对照组26例、双靶向组22例。分别进行单药培美曲塞或替吉奥化疗、常规治疗、甲磺酸阿帕替尼片联合靶向治疗,对比三组患者的临床疗效指标、随访结果与不良反应。结果双靶向组、化疗组的客观缓解率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)较对照组明显改善,差异均有统计学意义;而化疗组与双靶向组的ORR、DCR、总生存期(OS)指标对比、两组的OS与对照组对比差异无统计学意义。在安全性对比上,化疗组不良反应较双靶向组更为严重,但两组对比差异无统计学意义。结论对于EGFR-TKI获得性耐药的晚期非小细胞肺癌患者,序贯单药培美曲塞或者替吉奥化疗,或尝试联合甲磺酸阿帕替尼双靶向治疗可改善临床疗效、延长生存期并减轻不良反应,可应用于临床改善患者生活质量。
Objective To compare the efficacy of the targeted drug sequential pemetrexed with non-stop targeted drugs combined with apatinib in the treatment of advanced non-small cell lung cancer with EGFR-TKI acquired resistance. Methods A retrospective study was performed on 74 patients with advanced non-small cell lung cancer who progressed after EGFR-TKI treatment,including 26 in the chemotherapy group,26 in the control group,and 22 in the dual-targeted group. The single-agent pemetrexed or tiggio chemotherapy,conventional therapy,and apatinib mesylate tablets were combined with targeted therapy to compare the clinical efficacy indicators,follow-up results and adverse reactions of the three groups. Results The objective response rate( ORR),disease control rate( DCR),and progression-free survival( PFS) in the double-targeted group and the chemotherapy group were significantly improved compared with the control group,and the difference was statistically significant. There was no significant difference in ORR,DCR,and overall survival( OS) between the two groups,and there was no significant difference between the two groups. In terms of safety comparison,the adverse reactions in the chemotherapy group were more severe than those in the double-targeted group,but the difference between the two groups was not statistically significant. Conclusion For advanced EGFR-TKI acquired resistance of non-small cell lung cancer patients,sequential single-agent pemetrexed Gio or chemotherapy,or try mesylate apatinib combined dual targeting therapy can improve the clinical efficacy and prolong survival and reduce side effects,can be used clinically to improve the quality of life of patients.
Objective To compare the efficacy of the targeted drug sequential pemetrexed with non-stop targeted drugs combined with apatinib in the treatment of advanced non-small cell lung cancer with EGFR-TKI acquired resistance. Methods A retrospective study was performed on 74 patients with advanced non-small cell lung cancer who progressed after EGFR-TKI treatment,including 26 in the chemotherapy group,26 in the control group,and 22 in the dual-targeted group. The single-agent pemetrexed or tiggio chemotherapy,conventional therapy,and apatinib mesylate tablets were combined with targeted therapy to compare the clinical efficacy indicators,follow-up results and adverse reactions of the three groups. Results The objective response rate( ORR),disease control rate( DCR),and progression-free survival( PFS) in the double-targeted group and the chemotherapy group were significantly improved compared with the control group,and the difference was statistically significant. There was no significant difference in ORR,DCR,and overall survival( OS) between the two groups,and there was no significant difference between the two groups. In terms of safety comparison,the adverse reactions in the chemotherapy group were more severe than those in the double-targeted group,but the difference between the two groups was not statistically significant. Conclusion For advanced EGFR-TKI acquired resistance of non-small cell lung cancer patients,sequential single-agent pemetrexed Gio or chemotherapy,or try mesylate apatinib combined dual targeting therapy can improve the clinical efficacy and prolong survival and reduce side effects,can be used clinically to improve the quality of life of patients.
引文
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[4]林岩松,王宸,李慧,等.甲磺酸阿帕替尼治疗进展性碘难治性甲状腺癌的短期疗效及安全性初步报告[J].中国癌症杂志,2016,26(9):721-726.
[5]Bronte G,Bronte E,Novo G,et al.Conquests and perspectives of cardio-oncology in the field of tumor angiogenesistargeting tyrosine kinase inhibitor-based therapy[J].Expert Opinion on Drug Safety,2015,14(2):253.
[6]张宁刚,王育生.甲磺酸阿帕替尼片治疗原发性肝癌肺转移1例报道[J].肿瘤防治研究,2016,43(10):913-915.
[7]冯睿,张小田,杨升.胃癌靶向治疗的研究现状与进展[J].中华胃肠外科杂志,2016,19(10):1191-1196.
[8]刘红柳,杨家梅.培美曲塞单药或联合吉非替尼治疗EGFR-TKI耐药后晚期非小细胞肺癌临床观察[J].中国癌症杂志,2017,27(2):135-139.
[9]杜娟,刘宝瑞.阿帕替尼治疗晚期化疗耐药胃癌的临床体会[J].现代肿瘤医学,2016,24(3):2100-2104.
[10]周阳阳,秦叔逵,汪蕊,等.阿帕替尼治疗晚期胃癌伴顽固性癌性腹水4例[J].临床肿瘤学杂志,2016,21(5):476-478.
[2]赵鹏飞,曹邦伟.阿帕替尼治疗胃癌及其他肿瘤的研究现状[J].临床与病理杂志,2016,36(6):815-823.
[3]杨晓瑞,梁明杰,王伟兰.从1例溃疡型胃癌患者上消化道出血探讨抗血管生成药物的安全应用[J].中国药物应用与监测,2016,13(5):280-283.
[4]林岩松,王宸,李慧,等.甲磺酸阿帕替尼治疗进展性碘难治性甲状腺癌的短期疗效及安全性初步报告[J].中国癌症杂志,2016,26(9):721-726.
[5]Bronte G,Bronte E,Novo G,et al.Conquests and perspectives of cardio-oncology in the field of tumor angiogenesistargeting tyrosine kinase inhibitor-based therapy[J].Expert Opinion on Drug Safety,2015,14(2):253.
[6]张宁刚,王育生.甲磺酸阿帕替尼片治疗原发性肝癌肺转移1例报道[J].肿瘤防治研究,2016,43(10):913-915.
[7]冯睿,张小田,杨升.胃癌靶向治疗的研究现状与进展[J].中华胃肠外科杂志,2016,19(10):1191-1196.
[8]刘红柳,杨家梅.培美曲塞单药或联合吉非替尼治疗EGFR-TKI耐药后晚期非小细胞肺癌临床观察[J].中国癌症杂志,2017,27(2):135-139.
[9]杜娟,刘宝瑞.阿帕替尼治疗晚期化疗耐药胃癌的临床体会[J].现代肿瘤医学,2016,24(3):2100-2104.
[10]周阳阳,秦叔逵,汪蕊,等.阿帕替尼治疗晚期胃癌伴顽固性癌性腹水4例[J].临床肿瘤学杂志,2016,21(5):476-478.