Therapeutic efficacy of gefitinib and erlotinib in patients with advanced lung adenosquamous carcinoma

BackgroundAdenosquamous carcinoma (ASC) of the lung is a rare subtype of nonsmall-cell lung cancer (NSCLC). To date, the efficacious targeted therapy for advanced ASC remains unclear and the epidermal growth factor receptor (EGFR) mutation rate is not well known.MethodsWe retrospectively reviewed clinical information of patients with ASC who were treated with gefitinib or erlotinib at Zhejiang Cancer Hospital between January 2007 and December 2011. Survival analysis was evaluated by the Kaplan-Meier method. EGFR mutations were assessed in part using direct sequencing methods.ResultsIn total, 49 patients with a median age of 57 years were used in this study. Thirteen patients achieved a partial response and 19 had disease stabilization. The objective response rate was 26.5%, and the disease control rate was 65.3%. The median progression-free survival and overall survival were 4.3 and 17.6 months, respectively. In 21 patients with adequate specimens for molecular analysis, 7 (33.3%) had EGFR mutations (4 with deletions within exon 19 and 3 with L858R messenger mutation in exon 21). EGFR mutations were significantly more frequent in women (4/9, 44.4%) than men (3/12, 25%), never-smokers (6/15, 40%), and smokers (1/6, 16.7%).ConclusionEGFR-tyrosine kinase inhibitor (TKI) is an effective treatment for ASC. The frequency of EGFR mutation and clinical characteristics of the EGFR mutants in ASC are similar to those of Asian patients with adenocarcinoma.     

紫杉醇序贯吉非替尼对三维培养非小细胞肺癌细胞的抑制作用及其机制

目的:探讨序贯或联合吉非替尼(gefitinib,G)和紫杉醇(paclitaxel,P)对三维细胞模型中非小细胞肺癌(non-smallcell lung cancer,NSCLC)的抑制作用及其机制。方法:采用超低黏附表面细胞培养板培养人NSCLC细胞株A427、Calu-3,使其形成三维细胞模型;分别采用磺酸罗丹明B(sulforhodamine B,SRB)、Cell Titer-Blue法检测紫杉醇序贯吉非替尼(P-G)、吉非替尼序贯紫杉醇(G-P)及紫杉醇联合吉非替尼(P+G)处理对贴壁和三维培养细胞增殖的抑制作用,流式细胞术检测细胞周期,Western blotting检测细胞中EGFR和Akt总蛋白及其磷酸化的水平。结果:单层细胞培养时,P-G、G-P和P+G处理后,A427细胞的存活率分别为(39.5±0.07)%、(57.7±0.03)%和(53.7±0.05)%,Calu-3细胞的存活率分别为(23.9±0.02)%、(58.2±0.05)%和(48.8±0.07)%,以P-G的抑制作用最强(P<0.05);三维细胞模型中,P-G、G-P和P+G处理后,A427细胞的存活率分别为(19.9±2.89)%、(43.2±8.64)%和(36.6±9.79)%,Calu-3细胞的存活率分别为(10.2±0.76)%、(50.0±3.45)%和(31.4±6.15)%,也以P-G的抑制作用最强(P<0.05);而且,P-G对这两细胞的抑制作用,三维培养细胞显著强于单层培养细胞(P<0.05)。P-G治疗可提高subG1期细胞比例,并诱导细胞阻滞在G1期;P-G治疗可明显下调三维培养细胞中磷酸化Akt和磷酸化EGFR的水平。结论:三维细胞模型中,P-G较P+G或G-P对NSCLC细胞的增殖有更强的抑制作用,可能与细胞周期阻滞和磷酸化Akt、EGFR水平下调有关。     

EGFR-TKI治疗后缓慢进展的晚期NSCLC患者原药维持联合阿帕替尼的疗效及安全性

目的:观察一代EGFR-TKI治疗后缓慢进展的晚期NSCLC患者继续原药联合阿帕替尼的疗效及安全性。方法:收集2016年9月至2018年7月于大连医科大学附属第二医院肿瘤内科就诊的29例经一代EGFR-TKI单药治疗后缓慢进展（疾病控制≥6个月,与以往评估相比,肿瘤负荷较前轻度增加 2分,症状评分 1分）,继续原药维持联合阿帕替尼(250 mg／日1次)的晚期NSCLC患者的病例资料,观察客观缓解率（ORR）、疾病控制率（DCR）、中位无进展生存期（mPFS）及不良反应情况。结果:29例患者中,ORR为13.8%,DCR为86.2%,mPFS为5.470个月（95%CI 4.367~6.573个月）;常见的药物相关毒性反应是高血压、乏力和蛋白尿,经治疗后症状改善;其中4例经联合治疗一段时间后,临床症状稳定,出现病灶增大,但未达到疾病进展的患者,未换其他治疗方案,而是将阿帕替尼的用量加至500 mg／日1次,病灶再次稳定或缩小;L858R突变患者的mPFS比19号外显子缺失者显著延长,差异有统计学意义（P=0.011）。结论:一代EGFR-TKI治疗后缓慢进展的晚期NSCLC患者原药维持联合阿帕替尼治疗有效,且具有可接受可控的毒副作用。     

STE029逆转肺腺癌EGFR-TKI耐药及其机制研究

背景与目的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）获得性耐药和原发性耐药至今仍是临床治疗晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）的瓶颈。STE029是一种同时具有羟甲基戊二酸单酰辅酶A还原酶（3-hydroxy-3-methylglutarylcoenzyme A reductase, HMGCR）抑制剂抗肿瘤作用和肿瘤特异性细胞膜靶向功能的新型抗肿瘤药物。本研究旨在探讨STE029逆转肺腺癌EGFR-TKI的耐药机制。方法STE029、吉非替尼单药及联合用药分别处理PC9、PC9/BB4、A549细胞，检测各细胞株的活性变化、细胞增殖、细胞凋亡，鉴定EGFR/PI3K/Akt信号通路、细胞周期及凋亡相关蛋白的表达；同时观察STE029、吉非替尼单药及联合用药对PC9、PC9/BB4裸鼠皮下移植瘤生长的影响。结果① PC9细胞为EGFR突变的敏感细胞，PC9/BB4细胞为EGFR突变的获得性耐药细胞，A549细胞为非EGFR突变的耐药细胞；②STE029联合吉非替尼作用于PC9、PC9/BB4、A549细胞后，吉非替尼的半数抑制浓度（50% inhibitory concentration, IC₅₀）值较对照组均显著降低（P < 0.05）；③STE029联合吉非替尼可抑制PC9、PC9/BB4细胞的增殖（P < 0.001），诱导A549细胞凋亡增加（P < 0.01）；④在PC9、PC9/BB4细胞中，联合用药组较单药组p-EGFR、p-Akt的表达明显下调（P < 0.000,1），GSK-3β表达升高（P < 0.001），其下游p-Cyclin D1及Cyclin D1表达明显降低（P < 0.001），cleaved caspase-8、caspase-8、cleaved caspase-9、caspase-9的表达在各给药组间未见明显差异（P > 0.05）；在A549细胞中，联合用药组p-Akt表达明显下调（P < 0.001），cleaved caspase-8、cleaved caspase-9表达均升高（P < 0.001），而GSK-3β、p-Cyclin D1、Cyclin D1、caspase-8、caspase-9的蛋白表达在各给药组间则无明显差异（P > 0.05）；⑤裸鼠体内，联合用药组PC9皮下移植瘤的生长明显受到抑制，差异有明显统计学意义（P < 0.01）；联合用药组PC9/BB4皮下移植瘤的生长速率亦明显降低（P < 0.05）。结论STE029可在体内外明显增加非EGFR-T790M突变耐药的人肺腺癌细胞对吉非替尼的敏感性，其机制可能与STE029通过EGFR/PI3K/Akt信号通路调节GSK-3β、Cyclin D1的表达、阻滞细胞增殖、诱导细胞凋亡有关。     

表皮生长因子受体-酪氨酸激酶抑制剂分子耐药机制研究

以表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)为靶点的治疗近年逐渐引起关注。但部分患者在服用EGFR-TKI初期即出现原发和获得性耐药。本文综述EGFR-TKI分子耐药机制的研究现状,探讨EGFR-TKI分子耐药机制重要的临床意义。     

晚期非小细胞肺癌的二线治疗进展

晚期非小细胞肺癌一线化疗后仅能有一个较短暂的疾病缓解期,绝大部分患者需要进行二线治疗。目前推荐的二线治疗药物主要是多西紫杉醇、培美曲赛和EGFR-TKIs。多西紫杉醇最先确立其二线治疗的地位。培美曲赛通过一项与多西紫杉醇进行随机对照的Ⅲ期研究批准用于晚期NSCLC二线治疗。虽然培美曲赛毒性很轻微,但进一步的临床研究并没有发现高剂量对患者生存有益。EGFR-TKIs靶向治疗是目前研究的热点。吉非替尼和厄洛替尼单药二线治疗具有较好的疗效。吉非替尼与传统化疗对照的研究表明,其疗效不差于多西紫杉醇,且毒性较化疗轻微。厄洛替尼与化疗对照的研究正在进行。其它一些药物不断出现,显示了其在二线治疗的作用,例如口服拓扑替肯和长春氟宁与多西紫杉醇均具有相似的疗效。     

EGFR mutation status in plasma and tumor tissues in non-small cell lung cancer serves as a predictor of response to EGFR-TKI treatment

Objective: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) can effectively control non-small cell lung cancer (NSCLC). Therefore, EGFR mutations should be detected before lung cancer patients undergo EGFR-TKI therapy. This study assessed the feasibility and predictive value of EGFR mutations in peripheral blood samples.Methods: EGFR mutations in exons 19 and 21 were analyzed in tumor tissue and plasma DNA samples from 121 NSCLC patients using amplification refractory mutation system (ARMS) and the integrated technique of mutant enriched PCR (me-PCR) and denaturing high performance liquid chromatography (DHPLC), respectively.Results: EGFR mutations were detected in 36.4% of tumor tissues and 34.7% of the plasma at a concordance rate of 85.1% (103/121). The sensitivity and specificity of plasma EGFR mutations were 77.3% and 89.6%, respectively. The gender and tumor histology of patients served as independent predictors of EGFR mutations in both tumor tissues and plasma, while CEA level was an independent predictor of EGFR mutations in the plasma. Furthermore, EGFR-TKI treatment showed a significantly higher objective response rate (ORR), median progression-free survival (mPFS), and overall survival (mOS) in patients harboring EGFR mutation than those that did not exhibit EGFR mutation (ORR: 69.4% versus 13.0% in tissues, P < 0.001; 64.5 % vs. 28.6% in the plasma, P = 0.006. mPFS: 10.4 months versus 4.1 months in tissues, P<0.001; 10.5 months vs. 5.2 months in the plasma, P=0.001. mOS: 25.7 months versus 8.3 months in tissues, P=0.005; 25.7 months vs. 13.5 months in the plasma, P=0.038).Conclusions: EGFR mutations can be detected in the plasma using the integrated technique of me-PCR and DHPLC, which enables us to predict patient response to EGFR-TKI therapy. High serum CEA levels served as an independent predictor for plasma EGFR mutations.     

Clinical significance of epidermal growth factor receptor tyrosine kinase inhibitors: Sensitivity and resistance

Gefitinib and erlotinib, which are epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKIs), are highly effective against lung tumors with EGFR activating mutations. However, in 20–30% of cases, there is intrinsic resistance, and even if the treatment is effective, resistance is acquired in one to several years. Possible mechanisms of acquired resistance to EGFR-TKI, thus far, include a gatekeeper mutation of EGFR, activation of an alternate pathway, activation of EGFR downstream signals, transformation to small cell lung cancer, and epithelial–mesenchymal transition (EMT). Recently, BIM (BCL2L11), which is a BH3-only proapoptotic member of the Bcl-2 protein family, was shown to play a central role in inducing apoptosis in response to EGFR-TKI treatment in EGFR mutant lung cancer cells. Moreover, when the expression of active BIM protein was low, there was resistance to apoptosis induction by EGFR-TKI treatment and early disease progression.A polymorphism of the BIM gene unique to East Asian people has been detected and is now attracting attention as a factor causing resistance to EGFR-TKI due to decreased BIM activity.     

晚期非小细胞肺癌二线靶向治疗失败后不同治疗方案的比较

目的回顾性分析晚期非小细胞肺癌（NSCLC）在二线表皮生长因子受体酪氨酸激酶抑制剂（EGFR—TKI）治疗失败后接受不同治疗方案对无进展生存期及生存时间的关系。方法收集我院2007年1月1日-2012年5月1日具有明确细胞或组织学类型,临床分期为ⅢB或Ⅳ期的NSCLC患者120例,且明确接受过二线靶向治疗后经证实疾病进展的相关临床资料。结果120例患者EGFR—TKI治疗经证实失败后,分别接受了最佳支持治疗（BSC）,单药化疗以及含铂方案的两药联合化疗,对其基本情况进行分析,显示不同方案的无进展生存期（Progression—Free Survival,PFS）和整体生存期（Overall Survival,OS）与性别、年龄无关;化疗,尤其是含铂方案的联合化疗能明显提高其疾病无进展期及生存时间,P均〈0．05,差异具有统计学意义。结论晚期NSCLC患者在靶向治疗失败后,化疗,尤其是含铂方案的联合化疗能明显提高患者的PFS及生存时间。     

EGFR-TKI治疗EGFR敏感突变的晚期肺鳞癌的疗效分析

目的 探讨表皮生长因子酪氨酸激酶抑制剂（Epidermal growth factor receptor-tyrosine kinase inhibitor, EGFR-TKI）治疗EGFR敏感突变的晚期肺鳞癌患者的疗效。方法 收集20例四川大学华西医院经病理确诊、EGFR检测敏感突变、并接受EGFR-TKI治疗的Ⅳ期或术后复发转移肺鳞癌患者,分析其与EGFR-TKI的疗效关系。结果 20例EGFR敏感突变的晚期鳞癌患者接受EGFR-TKI治疗,随访资料完整。10例19-del（+）,8例L858R（+）,1例同时存在外显子21（L858R）点突变和外显子20（T790M）突变,1例外显子18（G719X）突变。其中部分缓解（PR）9例,疾病稳定（SD）7例,疾病进展（PD）4例。客观缓解率（ORR）45%,疾病控制率80%,中位无进展生存期（mPFS）为5.0月,中位生存期（mOS）为14.7月。结论 EGFR-TKI对部分EGFR敏感突变的鳞癌患者有一定疗效。在临床工作中,应重视这部分患者的EGFR基因检测,以便明确获益的患者。