EGFR突变对云南省晚期肺腺癌疗效及预后影响的真实世界研究

目的 研究云南省肺腺癌患者表皮生长因子受体(epidermal growth factor receptor,EGFR)突变检测情况、表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI)应用情况及晚期肺...     

胰岛素生长因子-1受体信号通路与肺癌的研究进展

自1986年首次克隆了胰岛素生长因子-1受体(insulin-like growth factor-1 receptor,IGF-IR)以后,人们围绕通过IGF-IR介导的经典的磷酸化激活的信号通路做了很多工作.在这条通路中,IGF-IR调节了细胞的增殖、运动、凋亡和死亡,使得我们又重新审视了生长激素(growth hormone,GH)-胰岛素样生长因子(insulinlike growth factor,IGF)-胰岛素样生长因子结合蛋白(insulin-like growth factor binding protein,IGFBP)轴在肿瘤发生发展中的作用.     

Akt介导的信号通路在肿瘤淋巴管生成中的作用

肿瘤淋巴管生成不但为肿瘤的生长代谢提供营养物质,同时也是肿瘤淋巴结转移的重要条件。但是肿瘤淋巴管新生的分子机制十分复杂,需要多种生长因子、受体和信号通路的调控。Akt处于多条信号通路的重要交叉点,激活的Akt在肿瘤侵袭转移中具有十分重要的意义。血管内皮生长因子（vascular endothelial growth factor,VEGF）,成纤维细胞生长因子-2(fibroblast growth factor-2,FGF-2)、胰岛素样生长因子(insulin-like growth factor,IGF)、肝细胞生长因子（hepatocyte growth factor,HGF）等分子对淋巴管生成的促进作用都是直接或间接地通过Akt信号通路介导来实现的。     

胃癌组织中VEGF、bFGF表达及与微血管计数的关系

肿瘤的生长和转移均需血管生成,血管生成与促血管生成因子有关.主要促血管生成因子有:血管内皮生长因子(vascular endothelial growth factorVEGF)、碱性成纤维细胞生长因子(basic fibroblast growth factorbFGF)和血小板衍生生长因子(platelet derived growth factorPDGF).近年研究发现VEGF、bFGF和PDGF表达与恶性肿瘤血管生成、生物学行为及预后有关.作者应用免疫组化研究胃癌组织中VEGF、bFGF表达及与微血管计数(microvessel countMVC)的关系.     

甲磺酸阿帕替尼治疗恶性肿瘤的研究进展

摘 要：分子靶向治疗在恶性肿瘤的治疗中占重要地位,甲磺酸阿帕替尼(apatinibmesylate)是一种新型的抗肿瘤分子靶向药,其机制为作用于血管内皮生长因子(vascular endothelial growth factor,VEGF)及血管内皮生长因子受体(vascular endothelial growth factor receptor,VEGFR)信号通路。全文就甲磺酸阿帕替尼抗肿瘤作用机制、临床试验及基础研究等方面的研究进展进行综述。     

维生素D抗结直肠癌的研究进展

结直肠癌是一种常见的恶性肿瘤,其发病机制涉及多个方面。目前流行病学及基础研究均支持,维生素D缺乏可能是导致结直肠癌的危险因素之一。进一步研究显示,维生素D与维生素D受体结合后可调节c-myc、抗凋亡因子B细胞性淋巴瘤-2(B cell lymphoma-2,Bcl-2)、表皮生长因子受体(epidermal growth factor receptor,EGFR)和血管内皮生长因子(vascular endothelial growth factor,VEGF)等与肿瘤分化、增殖、凋亡及血管形成相关的基因,从而发挥抗结直肠癌的作用。此外,维生素D还可通过调节Wnt、表皮生长因子(epidermal growth factor,EGF)和转化生长因子-β(transforming growth factor-β,TGF-β)等信号通路来拮抗结直肠癌。因此,本文将对维生素D抗结直肠癌相关的研究现况作一综述,以期为结直肠癌的防治提供一些新的线索。     

非小细胞肺癌EGFR突变的检测方法

非小细胞肺癌(non-small cell lung cancer,NSCLC)是严重危害人类健康的常见恶性肿瘤。近年来表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptortyrosine kinase inhibitor,EGFR-TKI)为NSCLC的治疗带来新的曙光,但用药前必须依据表皮生长因子受体(epidermalgrowth factor receptor,EGFR)的突变检测结果选择治疗对     

胃癌组织中VEGF、bFGF表达及与微血管计数的关系

肿瘤的生长和转移均需血管生长,血管生成与促血管生成因子有关。主要促血管生成因子有：血管内皮生长因子（vascular endothelial growth factor,VEGF)、碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF）和血小板衍生生长因子（platelet derived growth factor,PDGF),近年研究发现VEGF、bFGF和PDGF表达与恶性肿瘤血管生成、生物学行为及预后有关。作者应用免疫组化研究胃癌组织中VEGF、bFGF表达及与微血管计数（microvessel coumt,MVC)的关系。     

手术时机对绝经前乳腺癌术后复发转移的影响

国内外对于绝经前乳腺癌手术时机的选择问题仍有争议 , 但多数资料显示 , 黄体期手术者预 后较好 [1- 4]. 本课题通过回顾分析 164例绝经前乳腺癌术后 5年复发转移的危险因素 , 探讨 是否在黄体期手术有利于病人无瘤生存 ; 同时 , 通过检测表皮生长因子受体 ( epidermal growth factor receptor, EGFR) 和血管内皮生长因子 ( vascular endothelial growth factor, VEGF) 探讨其可能的原因 .     

表皮生长因子受体和血管内皮细胞生长因子受体之外肺癌靶向治疗新进展

目前肺癌的生物靶向治疗已进入临床治疗阶段,以吉非替尼、厄洛替尼和西妥昔单抗为代表的抗表皮生长因子受体(epidermal growth factor receptor, EGFR)通路的药物和以贝伐单抗为代表的抗血管内皮细胞生长因子受体(vascular endothelial cell growth factor receptor, VEGFR)通路的药物已成功地应用于肺癌临床治疗.然而,肺癌分子生物学机制十分复杂,以EGFR和VEGFR信号通路为靶点的治疗存在局限和不足.近年来,肺癌新的分子生物靶点逐渐受到关注,例如棘皮动物微管相关蛋白4/间变淋巴瘤激酶(echinoderm microtubule-associated protein-like 4/anaplastic lymphoma kinase, EML4-ALK)融合基因、哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin, mTOR)、胰岛素样生长因子Ⅰ型受体(insulin-like growth factor type Ⅰ receptor, IGF-1R)和间质上皮转变因子(mesenchymal-epithelial transition factor, c-MET)等.本文对上述分子生物学标志物在肺癌治疗中的作用及其相关临床研究进展进行综述.     

表皮生长因子受体突变晚期非小细胞肺癌靶向治疗效果影响因素分析

目的:探讨表皮生长因子受体（EGFR）突变晚期非小细胞肺癌（NSCLC）EGFR-酪氨酸激酶抑制剂（EGFR-TKI）治疗效果的影响因素。方法:收集2015年1月至2019年10月南京医科大学附属无锡第二医院接受EGFR-TKI治疗的104例EGFR突变晚期NSCLC患者的临床资料。分析EGFR突变类型与患者的临床病理...     

一线EGFR-TKIs联合血管生成抑制剂治疗晚期EGFR突变非小细胞肺癌的疗效分析

目的:比较一线表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs)联合血管生成抑制剂对比EGFR-TKIs单药治疗晚期EGFR突变非小细胞肺癌(non-small cell lung cancer, NSCLC)的疗效和安全性。方法:对PubMed、Embase、Web of Science和Cochrane Library数据库以及欧洲医学肿瘤学会(ESMO)、美国临床肿瘤学会(ASCO)中会议摘要进行了全面的文献检索。检索时间截止至2020年11月13日。使用STATA V.14.0对相关数据进行统计分析。结果:本meta共纳入6个II/III期RCTs(11篇文章),包括1 537例符合分析条件的NSCLC患者。结果表明,与EGFR-TKIs单药组相比,联合血管生成抑制剂组患者的无进展生存期(progression-free survival, PFS)显著延长(HR=0.62,95%CI 0.54～0.70,P<0.001)。然而,联合治疗并不能改善...     

阿法替尼治疗晚期非小细胞肺癌的Meta分析

目的:评价阿法替尼治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效及安全性.方法:通过PubMed、The Cochrane Library、Web of Science、EMbase、万方数据库和中国期刊全文数据库,检索阿法替尼治疗晚期NSCLC的随机临床对照试验.提取资料,采用RevMan5.3进行Meta分析.结果:纳入6项RCT研究,2 610例患者,荟萃分析显示阿法替尼治疗可显著延长晚期NSCLC的无进展生存期(progression-free survival,PFS)(HR=0.59,95%CI:0.46~0.74,P<0.000 1).亚组分析示阿法替尼组较传统化疗组(HR=0.54,95%CI:0.45~0.64,P<0.000 01)及一代EGFR-TKI组(HR=0.79,95%CI:0.67~0.92,P=0.002)PFS改善更加明显,差异有统计学意义.同时,阿法替尼治疗亦可延长患者的总生存期(overall survival,OS)(HR=0.90,95%CI:0.82~0.99,P=0.03).亚组分析示阿法替尼组较一代EGFR-TKI组(HR=0.82,95%CI:0.72~0.95,P=0.006)OS改善更加明显,差异有统计学意义;而与传统化疗组(HR=0.93,95%CI:0.78~1.10,P=0.38)相比,OS改善未显示出明显优势.安全性方面,阿法替尼治疗最主要的不良反应为腹泻(RR=9.99,95%CI:5.61~17.78,P<0.000 01)和口腔炎(RR=14.67,95%CI:4.72~45.56,P<0.000 01)而皮疹、乏力、食欲下降、恶心、呕吐不良反应,两组差异均无统计学意义.结论:阿法替尼治疗可延长晚期NSCLC患者的PFS及OS,与传统化疗及一代EGFR-TKI相比有明显优势.并具有良好安全性,可作为药物治疗晚期NSCLC的优先选择.     

Epidermal growth factor receptor-tyrosine kinase inhibitor therapy is effective as first-line treatment of advanced non-small-cell lung cancer with mutated EGFR: A meta-analysis from six phase III randomized controlled trials

Gefiinib and erlotinib are two similar small molecules of selective and reversible epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), which have been approved for second-line or third-line indication in previously treated advanced Non-small-cell lung cancer (NSCLC) patients. The results of comparing the EGFR-TKI with standard platinum-based doublet chemotherapy as the first-line treatment in advanced NSCLC patients with activated EGFR mutation were still controversial. A meta-analysis was performed to derive a more precise estimation of these regimens. Finally, six eligible trials involved 1,021 patients were identified. The patients receiving EGFR-TKI as front-line therapy had a significantly longer progression-free survival (PFS) than patients treated with chemotherapy [median PFS was 9.5 versus 5.9 months; hazard ratio (HR)=0.37; 95% confidence intervals (CI)=0.27-0.52; p<0.001]. The overall response rate (ORR) of EGFR-TKI was 66.60%, whereas the ORR of chemotherapy regimen was 30.62%, which was also a statistically significant favor for EGFR-TKI [relative risk (RR)=5.68; 95% CI=3.17-10.18; p<0.001]. The overall survival (OS) was numerically longer in the patients received EGFR-TKI than patients treated by chemotherapy, although the difference did not reach a statistical significance (median OS was 30.5 vs. 23.6 months; HR=0.94; 95% CI=0.77-1.15; p=0.57). Comparing with first-line chemotherapy, treatment of EGFR-TKI achieved a statistical significantly longer PFS, higher ORR and numerically longer OS in the advanced NSCLC patients harboring activated EGFR mutations, thus, it should be the first choice in the previously untreated NSCLC patients with activated EGFR mutation.     

EGFR-TKI一线治疗不同EGFR突变状态晚期非小细胞肺癌疗效分析

目的：分析表皮生长因子受体酪氨酸酶抑制剂（EGFR-TKI）一线治疗不同EGFR突变状态（外显子19缺失、21突变）晚期非小细胞肺癌（NSCLC）的疗效。方法收集徐州市肿瘤医院经组织病理学证实的EGFR突变阳性晚期NSCLC患者72例,分析两种不同EGFR突变状态与一线EGFR-TKI治疗的客观缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）以及总生存期（OS）之间的关系。结果72例患者均进行EGFR基因检测,其中37例为EGFR19外显子缺失,35例为EGFR21外显子突变。72例患者均可评价疗效,其中EGFR19外显子缺失的患者ORR 75．7％,DCR 89．2％;EGFR21外显子突变的患者ORR 51．4％,DCR 68．6％,差异均有统计学意义（χ2＝4．583,P＝0．032;χ2＝4．636,P＝0．031）。EGFR19外显子缺失和21外显子突变的患者校正后的中位PFS分别为13．2个月、10．8个月,差异有统计学意义（χ2＝4．700,P＝0．030）;中位OS分别为30．2个月、25．6个月,差异有统计学意义（χ2＝4．686,P＝0．030）。两组间不良反应无明显差别,皮疹最为常见,两组差异无统计学意义（48．7％∶48．6％,χ2＝0．000,P＝0．995）。结论 EGFR突变状态是晚期NSCLC患者一线EGFR-TKI治疗疗效和OS的预测因素,EGFR19外显子缺失患者的疗效优于EGFR21外显子突变患者。     

EGFR靶向治疗与培美曲塞序贯使用治疗晚期肺癌的临床研究

目的:本研究旨在探索表皮生长因子受体(epidermal growth factor receptor,EGFR)靶向治疗与培美曲塞序贯使用治疗晚期EGFR突变阳性肺癌的疗效。方法:本研究为回顾性研究。回顾性分析四川大学华西医院2013年至2016年收治的非小细胞肺癌(non-small cell lung cancer,NSCLC)患者,筛选条件:患者必须为Ⅲb／Ⅳ期,且携带EGFR突变;年龄大于等于18岁,并有可评价靶病灶;采用TKI作为一线用药,培美曲塞作为二线治疗,或相反顺序。分别采集一线和二线用药的PFS。按照应用培美曲塞化疗和靶向治疗的先后顺序分为CT组(先化疗后靶向治疗)和TC组(先靶向治疗后化疗);分别收集一线和二线PFS及总的PFS。结果:我们筛选了共637位患者(吉非替尼组n=455,埃克替尼组n=95,厄洛替尼组n=87),从中纳入了46位患者。病理类型以腺癌为主(n=44,95.7%)。EGFR突变状态以19外显子缺失(n=19,41.3%)及21外显子L858R错义点突变(n=18,38.1%)为主,其它少见突变共9例(19.1%)。性别:男(n=23) vs 女(n=23);ECOG:0(n=25) vs 1(n=21);吸烟(n=21) vs 不吸烟(n=25);年龄中位数为53岁。整个研究人群中,总的PFS为16.0月(95%CI:12.9~19.1月)。TC组与CT组的PFS分别为18.1月(95%CI:12.8~23.4月)及11.9月(95%CI:9.1~14.5月),两组之间没有明显差异(P=0.447,HR=0.836,95%CI:0.401~1.742)。两组病例的靶向治疗及化疗PFS分别进行比较。一线(10.2月,95%CI:8.9~11.4月)及二线(11.5月,95%CI:8.2~14.8月)应用靶向治疗的PFS时间相当 (P=0.808,HR=1.306,95%CI:0.655~2.605)。相似的,一线(3.5月,95%CI:0.0~8.0月)及二线(6.2月,95%CI:2.8~9.6月)化疗的PFS时间基本相当(P=0.750,HR=0.837,95%CI:0.423~1.659)。结论:对于携带EGFR突变的晚期NSCLC患者,EGFR-TKI和培美曲塞序贯治疗均可以获得较好的PFS。     

EGFR-TKI一线治疗EGFR基因突变的晚期非小细胞肺癌临床观察

背景与目的研究表明,一线表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptortyrosine kinase inhibitor,EGFR-TKI)治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的客观缓解率及无进展生存期明显优于铂二联的化疗,且耐受性更好。本研究旨在分析EGFR-TKI一线治疗晚期EGFR突变阳性的NSCLC患者的疗效与耐受性。方法 54例晚期NSCLC患者肿瘤标本采用直接测序法证实EGFR活化突变(外显子19缺失或外显子21点突变),一线给予EGFR-TKI口服治疗直至疾病进展,观察疗效及不良反应,并进行生存随访。结果 54例患者外显子19缺失33例(61%),外显子21点突变21例(39%)。均一线接受EGFR-TKI治疗,总体缓解率为90%,中位无进展生存期(progression free survival,PFS)为8.3个月,中位生存期为19.5个月;外显子19缺失患者的中位PFS(9.0个月)较21点突变(7.0个月)时间长(P=0.002)。外显子19缺失患者的中位总生存期(overall survival,OS)(25.0个月)较21点突变(16.0个月)时间长(P=0.001);吉非替尼与厄洛替尼疗效相当,但吉非替尼组安全性更好;最常见的不良事件为皮疹和腹泻,有2例患者(4%)出现了3度皮肤毒性反应,2例患者(4%)出现了3度的转氨酶升高,1例患者(1%)出现了3度口腔炎。结论存在EGFR基因突变的晚期NSCLC患者一线接受EGFR-TKI治疗安全有效,且外显子19缺失比L858R突变疗效更优。     

Meta-analysis of Seven Randomized Control Trials to Assess the Efficacy and Toxicity of Combining EGFR-TKI with Chemotherapy for Patients with Advanced NSCLC who Failed First-Line Treatment

Background: Some recent clinical trials have been conducted to evaluate a combination of EGFR- TKI withchemotherapy for advanced NSCLC patients as second-line therapy, but the results on the efficacy of such trialsare inconsistent. The aim of this meta-analysis was to evaluate the efficacy and safety of combination of EGFR-TKIand chemotherapy for patients with advanced NSCLC who failed first-line treatment. Materials and Methods:We searched relative trials from PubMed, EMBASE, ASCO Abstracts, ESMO Abstracts, Cochrane Libraryand Clinical Trials.gov. Outcomes analyzed were overall response rate (ORR), progression- free survival (PFS),overall survival (OS) and major toxicity. Results: Seven trails eventually were included in this meta-analysis,covering 1,168 patients. The results showed that the combined regimen arm had a significant higher ORR (RR1.76 [1.16, 2.66], p=0.007) and longer PFS (HR 0.75 [0.66-0.85], p<0.00001), but failed to show effects on OS (HR0.88 [0.68- 1.15], p=0.36). In terms of subgroup results, continuation of EGFR-TKI in addition to chemotherapyafter first-line EGFR-TKI resistance confered no improvement in ORR (RR 0.95 [0.68, 1.33], p=0.75) and PFS(HR 0.89[0.69, 1.15], p=0.38), and OS was even shorter (HR1.52 [1.05- 2.21], p=0.03). However, combinationtherapy with EGFR-TKI and chemotherapy after failure of first-line chemotherapy significantly improvedthe ORR (RR 2.06 [1.42, 2.99], p=0.0002), PFS (HR 0.71 [0.61, 0.82], p<0.00001) and OS (HR 0.74 [0.62- 0.88],p=0.0008), clinical benefit being restricted to combining EGFR-TKI with pemetrexed, but not docetaxel. Grade3-4 toxicity was found at significantly higher incidence in the combined regimen arm. Conclusions: Continuationof EGFR-TKI in addition to chemotherapy after first-line EGFR-TKI resistance should be avoided. Combinationtherapy of EGFR-TKI and pemetrexed for advanced NSCLC should be further investigated for prognostic andpredictive factors to find the group with the highest benefit of the combination strategy.     

Tumor-associated macrophages correlate with response to epidermal growth factor receptor-tyrosine kinase inhibitors in advanced non-small cell lung cancer

Our study investigated whether tumor-associated macrophages (TAMs) in advanced non-small cell lung cancer (NSCLC) are related to treatment response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and may be a predictor of survival. Of 206 advanced NSCLC patients treated (first-line) with an EGFR-TKI at the study hospital from 2006 to 2009, 107 with adequate specimens for assessing CD68 immunohistochemistry as a marker of TAMs were assessed. After EGFR-TKI treatment, response was observed in 55 (51%) patients, and the median follow-up period was 13.5 months. Most TAMs were located in the tumor stroma (>95%) and positively costained with the M2 marker CD163. TAM counts were significantly higher in patients with progressive disease than in those without (p < 0.0001), a trend that remained in patients with known EGFR mutation status (n = 59) and those with wild-type EGFR (n = 20). High TAM counts, among other factors (e.g., wild-type EGFR), were significantly related to poor progression-free survival (PFS) and overall survival (OS) (all p < 0.0001 for TAMs). Multivariate Cox analyses showed that high TAM counts and EGFR mutations were both independent factors associated with PFS [odds ratio (OR), 8.0; 95% confidence interval (CI), 2.87-22.4; p = 0.0001 and OR, 0.03; 95% CI, 0.003-0.31; p = 0.003, respectively] and OS (OR, 2.641; 95% CI, 1.08-6.5; p = 0.03 and OR, 0.14; 95% CI, 0.03-0.56; p = 0.006, respectively). TAMs are related to treatment response irrespective of EGFR mutation and can independently predict survival in advanced NSCLC treated with an EGFR-TKI.     

PD-1/PD-L1 抑制剂联合化疗对比化疗一线治疗晚期非小细胞肺癌疗效及安全性的Meta分析

目的：系统评价PD-1/PD-L1 抑制剂联合化疗对比化疗一线治疗晚期非小细胞肺癌（non-small lung cancer,NSCLC）的疗效及安全性。方法：检索PubMed、Cochrane Library、EMbase、EBSCO循证医学数据库、中国生物医学文献数据库（Chinese Biomedical Literature Database,CBM）、中国知网（Chinese Journal Full-text Database,CNKI）、中文科技期刊全文数据库（VIP）中收录的PD-1/PD-L1 抑制剂联合化疗对比化疗一线治疗晚期NSCLC 的随机对照试验（randomized controlled trials,RCTs）,采用RevMan 5.2 软件进行Meta 分析。结果：纳入6 个临床RCTs 共3 238 例晚期NSCLC。Meta 分析结果显示,PD-1/PD-L1 抑制剂联合化疗与化疗相比可显著延长OS（HR=0.86,95%CI=0.79~0.94,P=0.0006）和PFS（HR=0.81,95%CI=0.78~0.84,P<0.00001）;1~5 级血小板计数减少、呕吐、腹泻、甲状腺功能减低或亢进、皮疹、肺炎、结肠炎、肝炎、味觉障碍,3~5 级肝炎的不良反应发生率较化疗组高,差异具有统计学意义（P<0.01 或P<0.05）。结论：PD-1/PD-L1 抑制剂联合化疗较单独化疗一线治疗晚期NSCLC可显著延长患者OS和PFS,但不良反应发生率较化疗高。