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既往吉非替尼治疗获益的晚期NSCLC患者再次使用EGFR—TKI的选择：原药还是换药
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既往吉非替尼治疗获益的晚期NSCLC患者再次使用EGFR—TKI的选择：原药还是换药
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Journal Article
既往吉非替尼治疗获益的晚期NSCLC患者再次使用EGFR—TKI的选择：原药还是换药
2013
Overview
背景与目的既往表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor recepto rtyrosine kinase inhibitor，EGFR-TKI）治疗获益的晚期非小细胞肺癌（non-small cell lung cancer.NSCLC）患者，再次给予TKI治疗，已逐渐成为一种新的治疗策略。本研究旨在探讨二次TKI治疗时，原药或换药，哪一种选择更为合理。方法回顾晚期或术后复发的NSCLC患者，既往吉非替尼治疗疗效达到完全缓解（complete response，CR）、部分缓解（partial response,PR）或稳定（stable disease，SD），无进展生存期（progression free survival，PFS）≥3个月，病情进展后，间隔时间至少1个月，分别接受吉非替尼或厄洛替尼治疗。就两组患者的疗效、优势人群等进行分析。结果共有6l例患者人组，其中吉非替尼组30例，厄洛替尼组3l例，两组患者基线特征基本平衡。吉非替尼组与厄洛替尼组疗效比较，有效率（response rate，RR）（10％vs22．6％，P=O．300，6）、疾病控制率（disease contral rate，DCR）（60％VS74．2％，P=O．237，8）、中位PFS（3．0个月w3．5个月，P=0．494，5）、中位总生存期（overallsurvival，OS）（8．3个月VS8．5个月，P=0．140，8）均未见统计学差异。多因素分析示：首次吉非替尼PFS_〉6个月（HR=O．317，95％CI：0．102—0．984，P=0．046，9），两次TKI间隔时间23个月（HR=O．224，95％CI：0．071—0．713，P=0．011,3）的患者疾病进展风险降低。而两次TKI间隔时间≥3个月（HR=0．262，95％CI：0．097．0．705，P=0．008，0）的患者死亡风险降低。结论既往吉非替尼治疗获益的晚期NSCLC患者再次TKI治疗，无论选择吉非替尼还是换用厄洛替尼均可获益，这种获益与首次TKI的PFS、以及两次TKI的间隔时间相关。
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