吉非替尼联合化疗治疗靶向治疗失败的EGFR T790M野生型晚期肺腺癌的疗效观察

目的:探讨吉非替尼联合化疗治疗靶向治疗失败的EGFR T790M野生型晚期肺腺癌的疗效和安全性。方法:63例靶向治疗失败的EGFR T790M野生型的晚期肺腺癌患者分为口服吉非替尼（250 mg qd）联合化疗［（培美曲塞（500 mg/m2 d1）+顺铂（75 mg/m2 d1）］组（联合组33例）和培美曲塞（500 mg/m2 d1）+顺铂（75 mg/m2 d1）化疗组（化疗组30例），21天为一个周期。对患者的近期疗效和毒副反应进行比较。结果:联合组共33例，其中CR 0例，PR 13例，SD 14例，PD 6例；化疗组共30例，其中CR 0例，PR 11例，SD 12例，PD 7例。两组的客观缓解率分别为39.4%和36.7%，两者差异无统计学意义（P＞0.05）。两组疾病控制率分别为81.8%和76.7%，两者差异无统计学意义（P＞0.05）。联合组中位无疾病进展期显著高于化疗组（6.2个月 vs 4.6个月，P＜0.05）。两组的血液学毒性和非血液学毒性发生率差异均无统计学意义（P＞0.05）。结论:吉非替尼联合化疗二线治疗EGFR T790M野生型晚期肺腺癌疗效可靠，毒副反应可耐受。

Curative effect observation of gefitinib combined with chemotherapy in the treatment of advanced lung adenocarcinoma harboring EGFR T790M wild type with failed target therapy

Objective:To explore the efficacy and safety of gefitinib combined with chemotherapy in the treatment of advanced lung adenocarcinoma harboring EGFR T790M wild type with failed target therapy.Methods:63 patients were assigned to combined treatment group and chemotherapy group.Combined group(33 patients) was given gefitinib(250 mg qd) plus pemetrexed(500 mg/m2 d1) and cisplatin(75 mg d1),and the chemotherapy group(30 patients) was given pemetrexed(500 mg/m2 d1) and cisplatin(75 mg d1).One cycle was composed of 21 days.Results:There were 33 patients in combined treatment group,including 0 case of CR,13 cases of PR,14 cases of SD and 6 cases of PD.There were 30 patients in chemotherapy group,including 0 case of CR,11 cases of PR,12 cases of SD and 7 cases of PD.No statistical difference was observed between two groups in terms of objective remission rate(39.4% vs 36.7%) and disease control rate(81.8% vs 76.7%).PFS was significantly prolonged with combined treatment group(6.2 months vs 4.6 months，P＜0.05).No statistical difference was observed between two groups in terms of hematologic toxicityand non hematologic toxicity(P＞0.05).Conclusion:Gefitinib combined with chemotherapy in the treatment of advanced lung adenocarcinoma harboring EGFR T790M wild type with failed target therapy was reliable,and the adverse reaction was tolerable.