厄洛替尼治疗吉非替尼耐药的进展期非小细胞肺癌的临床观察

目的　评价厄洛替尼对吉非替尼耐药的进展期非小细胞肺癌（ＮＳＣＬＣ）患者的疗效和安全性。方法　回顾性分析２００６年６月至２００９年２月１５例ＮＳＣＬＣ患者，均口服吉非替尼并出现病情进展，改换为厄洛替尼１５０ｍｇ，１次／日，直到病情进展或不良反应不能耐受为止。观察疗效、不良反应以及疗效与临床特征之间的关系。结果　厄洛替尼治疗吉非替尼耐药共１５例进展期ＮＳＣＬＣ患者，１例获得ＰＲ，４例获得ＳＤ，客观有效率为６.７％，疾病控制率为３３.３％。获有效和稳定的５例患者中４例曾吉非替尼治疗获益。厄洛替尼治疗的中位疾病进展期（ＴＴＰ）和中位总生存期（ＯＳ）分别为１１１天和２２３天。厄洛替尼获益的５例患者较未获益的１０例患者获得更长的ＴＴＰ（１１１天ｖｓ．３５.５天，Ｐ＜０.０５）。厄洛替尼最常见的副反应为轻度皮疹和腹泻。结论　厄洛替尼似乎是治疗吉非替尼耐药的进展期ＮＳＣＬＣ的有效药物，尤其是对于曾予吉非替尼治疗可以获益的患者，但厄洛替尼不应作为常规的二线选择，对患者谨慎筛选很有必要。

Erlotinib effect after gefitinib failure on the advanced non-small cell lung cancer

Objective To evaluate the efficacy and safety of erlotinib on the advanced non-small cell lung cancer（NSCLC） patients after failure of gefitinib treatment and study the relationship of efficacy and clinical characteristics. Methods We did a retrospective analysis of advanced NSCLC patients who previously treated with gefitinib and showed progression from June 2006 to February 2009. And then patients received erlotinib 150mg/d until disease progression or intolerable toxicity. The efficacy, side effects and the relationship between efficacy of two EGFR-TKIs and clinical characters were observed. Results A total of 15 NSCLC patients were enrolled in this study. Among 15 patients, one had a partial response and four had a stable disease, resulting in an objective response rate of 6. 7%, and a disease control rate of 33.3%. Four of five patients had benefit from gefitinib. The median time to progression and overall survival were 111 days and 223 days respectively. The patients who had obtained disease control with erlotinib, had showed a longer TTP （ 111 days vs. 35.5 days, P 〈 0. 05 ） to previous gefitinib than those who have progressed during erlotinib treatment. The most common toxic effects were skin rash and diarrhea. Conclusion Erlotinib seems to be effietive in patients with advanced NSCLC after failure of gefitinib, especially those who had benefit form prior gefitinib treatment. But erlotinib should not be given routinely. Careful selection of these patients is need.