阿法替尼和顺铂分别联合培美曲塞治疗晚期非小细胞肺癌的疗效分析

目的探究阿法替尼和顺铂分别联合培美曲塞治疗晚期EFGR突变型非小细胞肺癌晚期(non-small-cell carcinoma, NSCLC)的临床疗效差异，明确阿法替尼临床疗效。 方法选取我院2016年3月至2017年9月收治的107例EFGR突变阳性晚期NSCLC患者的病例资料，接受顺铂+培美曲治疗的NSCLC患者51例为对照组，接受塞阿法替尼+培美曲塞治疗的NSCLC患者56例，为研究组，观察两组患者疗效、无进展生存时间(progression-free survival time, PFS)以及生存时间(overall survival, OS)等。 结果研究组患者ORR及DCR比例均明显高于对照组53.57% vs. 31.37%，85.71% vs. 66.67%，P<0.05]；研究组患者PFS及OS均明显高于对照组7.2月vs. 6.0月，11.75月vs. 9.5月，P<0.05]；治疗后，研究组患者神经元特异性烯醇化酶(neuron-specific enolase, NSE)、癌胚抗原(carcinoembryonic antigen, CEA)、细胞角蛋白19片段(cytokeratin 19 fragment, CYFRA21-1)均低于对照组(11.79±8.51)ng/ml vs.(15.26±8.22)ng/ml，(14.54±8.77)ng/ml vs.(18.37±9.35)ng/ml，(3.45±2.68)ng/ml vs.(5.41±3.54)ng/ml，P<0.05]；Ⅰ～Ⅱ级不良反应中，研究组恶心呕吐、肾功能损害及脱发人数比例均明显低于对照组12.50% vs. 33.33%，5.36% vs. 27.45%，16.07% vs. 35.29%，P<0.05]，研究组皮疹/痤疮人数比例明显高于对照组25.00% vs. 7.84%，P<0.05]；治疗后，躯体方面、心理方面、社会方面及总体感觉评分均高于对照组(77.41±5.25)分vs.(72.12±5.08)分，(74.37±5.40)分vs.(67.52±5.32)分，(79.25±5.98)分vs.(74.32±5.71)分，(71.21±5.45)分vs.(66.61±5.20)分，P<0.05]。 结论阿法替尼联合培美曲塞一线治疗EGFR突变型晚期NSCLC患者的疗效更为显著，明显提高无进展生存时间及生存时间，明显提高生活质量，同时具有较高安全性，值得临床推广应用。

Clinical efficacies of Afatinib and cisplatin combined with pemetrexed in treatment of advanced non-small cell lung cancer

ObjectiveTo investigate the difference of clinical efficacies of Afatinib and cisplatin combined with pemetrexed respectively in the treatment of the patients with advanced EFGR mutant non-small cell lung cancer (NSCLC) so as to determine the clinical efficacy of Afatinib. MethodsA total of 107 patients with advanced EFGR mutant NSCLC treated in our hospital from March 2016 to September 2017 were selected for this study. Fifty-one patients treated with cisplatin+ pemetrexed were taken as the control group, while fifty-six patients treated with Afatinib+ pemetrexed were taken as the experimental group. The clinical efficacies, the progression-free survival time (PFST), and the overall survival (OS) were observed for all the patients. ResultsThe proportions of ORR and DCR in the experimental group were significantly higher than those of the control group (53.57% vs. 31.37% and 85.71% vs. 66.67%, respectively, P<0.05). The PFST and OS were significantly higher in the experimental group than the control group (7.2 months vs. 6.0 months and 11.75 months vs. 9.5 months, respectively, P<0.05). After treatment, the neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), and cytokeratin 19 fragment (CYFRA21-1) of the experimental group were lower than those of the control group (11.79±8.51) ng/ml vs. (15.26±8.22) ng/ml, (14.54±8.77) ng/ml vs. (18.37±9.35) ng/ml, and (3.45±2.68) ng/ml vs. (5.41±3.54) ng/ml, respectively, P<0.05]. The incidences of nausea and vomiting, renal impairment and hair loss in the experimental group were significantly lower than those of the control group (12.50% vs. 33.33%, 5.36% vs. 27.45%, and 16.07% vs. 35.29%, respectively, P<0.05). The incidence of rash/acne in the experimental group was significantly higher than that of the control group (25.00% vs. 7.84%, P<0.05). After treatment, the physical, psychological, social and overall sensory scores were higher in the experimental group than the control group (77.41±5.25) scores vs. (72.12±5.08) scores, (74.37±5.40) scores vs. (67.52±5.32) scores, (79.25±5.98) scores vs. (74.32±5.71) scores, and (71.21±5.45) scores vs. (66.61±5.20) scores, respectively, P<0.05]. ConclusionAfatinib combined with pemetrexed is more effective in the first-line treatment of advanced EGFR mutant NSCLC patients, significantly improves the PFST, the OS and the quality of life of the patients, and has a higher safety, which is worthy of clinical promotion and application.