EGFR靶向药物治疗不同类型晚期非小细胞肺癌的临床疗效分析

摘要

目的：探讨EGFR靶向药物在治疗不同类型晚期非小细胞肺癌（NSCLC）的临床疗效。方法对选择经病理证实的97例晚期NSCLC患者采用聚合酶链反应直接测序法进行EGFR基因突变的检测后分为EGFR突变型和EGFR野生型，所有患者均予厄洛替尼片150 mg口服，每天一次，于每天早晨饭前1～2 h内服用。持续服用直至肿瘤进展或发生不能耐受的不良反应。比较两种类型患者经EGFR靶向药物治疗后的临床有效率及控制率，以及无进展生存时间和生存时间，并对EGFR野生型患者进行COX回归分析影响生存期的因素。结果 EGFR突变型患者的有效率和控制率均明显高于野生型患者，差异均有统计学意义（χ2分别=12.83、14.45，P均＜0.05）。突变型患者无进展生存时间和总生存时间均高于野生型患者，差异均有统计学意义（t分别=4.30、3.18，P均＜0.05）。EGFR野生型患者的COX回归分析显示，病理类型（腺癌）、体力状态评分0～1分、无化疗史患者生存期较长（P＜0.05）。突变型和野生型患者不良事件中最常见的为皮疹和腹泻，突变型患者的不良反应发生率明显低于野生型患者（χ2=13.56，P＜0.05）。结论 EGFR治疗突变型晚期NSCLC疗效较野生型好，不良反应轻，EGFR基因突变可对其治疗效果进行预测。%Objective To investigate the clinical efficacy of epidermal growth factor receptor (EGFR) targeted drugs in the treatment of different types of advanced non-small cell lung cancer(NSCLC). Methods A total of 97 cases of NSCLC patients were divided into the mutant EGFR and wild-type EGFR according detection of EGFR gene mutation by direct se-quencing of PCR. All patients were given erlotinib tablets 150 mg orally, once a day, at 1 to 2 hours before breakfast until tumor progression or intolerable adverse reactions occurred. The clinical efficiency and control rates of two groups that after EGFR-targeted drug therapy were compared, and progression-free survival and median survival time were calculated by the Kaplan-Meier. Results The clinical efficiency and control rates of patients with mutant EGFR were significantly high-er than the wild-type EGFR patients (χ2=12.83, 14.45,P<0.05).The progression-free survival time and median survival time of mutant EGFR patients were significantly longer than the wild-type EGFR patients (t=4.30, 3.18,P<0.05). The COX regression showed that the survival time of patients whose pathological type was adenocarcinoma, performance status was 0 to 1 score and no history of chemotherapy were longer (P<0.05). The most common adverse events were rash and diarrhea. The incidence of adverse reactions of patients with mutant EGFR patients was significantly lower than the wild-type EGFR patients (χ2=13.56,P<0.05). Conclusion The treatment efficacy of mutant EGFR is better to wild-type EGFR because of the mild adverse reactions. EGFR gene mutations can predict its therapeutic effect.