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表皮生长因子受体酪氨酸激酶抑制剂单药或组合联合化疗对表皮生长因子受体突变晚期非小细胞肺癌患者无进展生存期的影响

Effects of individual or combination medication of epidermal growth factor receptor tyrosine kinase inhibitor combined with chemotherapy on progression-free survival in advanced non-small cell lung cancer patients with epidermal growth factor receptor mutation

    摘要
  • 摘要:
    目的 探讨表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)单药或组合联合化疗对表皮生长因子受体(EGFR)突变晚期非小细胞肺癌(NSCLC)患者无进展生存期(PFS)的影响。
    方法 选取2019年1月—2021年4月本院收治的110例EGFR突变晚期NSCLC患者为研究对象，根据治疗方案的不同分为A组37例(安罗替尼联合化疗)、B组32例(埃克替尼联合化疗)和C组41例(安罗替尼、埃克替尼联合化疗)。比较3组近期疗效，治疗前后血管生长因子水平以及不良反应发生情况。随访2年，应用Kaplan-Meier法绘制生存曲线，采用Log-rank比较3组生存率及PFS。
    结果 C组客观缓解率(ORR)为68.29%, 高于A组的43.24%和B组的40.62%, 差异有统计学意义(P < 0.05); 治疗后, C组血清血管内皮生长因子(VEGF)、成纤维细胞生长因子(bFGF)和血小板衍生生长因子(PDGF)水平低于A组和B组，差异有统计学意义(P < 0.05); C组不良反应总发生率为29.27%, 与A组的24.32%和B组的25.00%比较，差异无统计学意义(P>0.05)。截至末次随访时间, C组2年总生存率为74.29%, 高于A组的51.09%和B组的45.03%(Log-rank χ2=6.478, P=0.039); A组中位PFS为9.0个月, B组中位PFS为8.6个月, C组中位PFS为13.2个月, 差异有统计学意义(Log-rank χ2=6.264, P=0.043)。
    结论 EGFR-TKI组合用药联合化疗可有效提高EGFR突变晚期NSCLC患者ORR, 降低血清血管生长因子水平，延长PFS, 且安全性良好。

     

    Abstract:
    Objective To explore the effects of individual or combination medication of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) combined with chemotherapy on progression-free survival (PFS) in advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutation.
    Methods A total of 110 advanced NSCLC patients with EGFR mutation in our hospital from January 2019 to April 2021 were selected as research objects. According to different therapeutic plans, they were divided into group A with 37 cases (anlotinib chemotherapy), group B with 32 cases (icotinib chemotherapy) and group C with 41 cases (anlotinib plus icotinib and chemotherapy). The short-term effect, levels of vascular growth factors before and after treatment, and the incidence of adverse reactions were compared among the three groups. After 2 years of follow-up, survival curve was drawn by Kaplan-Meier method, and survival rate and PFS were compared in three groups by Log-rank.
    Results The objective response rate (ORR) was 68.29% in the group C, which was significantly higher than 43.24% in the group A and 40.62% in the group B (P < 0.05); after treatment, levels of serum vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) in the group C were significantly lower than those in the group A and the group B (P < 0.05); the total incidence of adverse reactions was 29.27% in the group C, which showed no significant differences when compared to 24.32% in the group A and 25.00% in the group B (P>0.05). By the time of the last follow-up, the 2-year overall survival rate was 74.29% in the group C, which was significantly higher than 51.09% in the group A and 45.03% in the group B (Log-rank χ2=6.478, P=0.039); the median PFS in the group A, the group B and the group C was 9.0, 8.6 and 13.2 months respectively, and differences were statistically significant (Log-rank χ2=6.264, P=0.043).
    Conclusion For the advanced NSCLC patients with EGFR mutations, combination medication of EGFR-TKI combined with chemotherapy can effectively increase ORR, reduce levels of serum vascular growth factors, prolong the PFS, and the safety is good.

     

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