论文部分内容阅读
目的观察贝伐珠单抗联合表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)治疗EGFR外显子19或21突变晚期非小细胞肺癌(NSCLC)患者的疗效差异。方法选择100例EGFR突变阳性的晚期NSCLC患者,其中EGFR外显子19突变50例,外显子21突变50例,将患者随机分为2组,分别使用方案A或B,方案A为贝伐珠单抗联合吉非替尼至进展,方案B为使用吉非替尼至进展。比较2组患者不良反应的发生率和客观缓解率(ORR)、肿瘤无进展生存期(PFS)、总体生存期(OS)。结果外显子19突变患者使用方案A者的ORR为92%,高于方案B者的68%(P<0.05);外显子21突变患者使用方案A者的ORR为88%,亦高于方案B者的60%(P<0.05)。外显子19突变患者使用方案A者的中位PFS为12.5个月,高于使用方案B者的9.0个月(P<0.05);外显子21突变患者使用方案A者的中位PFS为8.9个月,亦高于使用方案B者的7.0个月(P<0.01)。外显子19突变患者使用方案A者和B者的中位OS间比较差异无统计学意义(P>0.05);外显子21突变患者使用方案A者的中位OS(26.7个月)长于方案B者的23.8个月(P<0.01)。外显子19和外显子21突变患者使用方案A者的高血压和蛋白尿发生率高于方案B者(P均<0.05),但患者均可耐受。讨论贝伐珠单抗联合EGFR-TKI在EGFR突变阳性的晚期NSCLC一线治疗中可以作为新的选择方案,尤其应用于外显子21突变患者中可比单纯EGFR-TKI延长PFS和OS。
Objective To observe the curative effect of bevacizumab combined with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) on patients with EGFR exon 19 or 21 mutation in advanced non-small cell lung cancer (NSCLC). Methods One hundred patients with advanced NSCLC with EGFR mutation were selected, including 50 cases of EGFR exon 19 mutation and 50 cases of exon 21 mutation. The patients were randomly divided into two groups, using protocol A or B, Bezabi combined with gefitinib to progress, program B to use gefitinib to progress. The incidence of adverse reactions and objective response rate (ORR), tumor progression-free survival (PFS) and overall survival (OS) were compared between the two groups. Results The ORR of patients with exon 19 mutation was 92%, higher than that of patient B by 68% (P <0.05). The ORR of patients with exon 21 mutation was 88% Scenario B was 60% (P <0.05). Median PFS for program A patients with mutations in exon 19 was 12.5 months, up from 9.0 months for program B (P <0.05); median PFS for program A patients with mutations in exon 21 was 8.9 months, also higher than the use of program B were 7.0 months (P <0.01). There was no significant difference in the median OS between patients using exon 19 and patients A and B (P> 0.05). The median OS of patients with exon 21 mutation using protocol A (26.7 months) Plan B were 23.8 months (P <0.01). Patients with mutations in exon 19 and exon 21 had higher rates of hypertension and proteinuria than those in protocol B (all P <0.05), but patients were well tolerated. Discussion Bevacizumab combined with EGFR-TKI can be a new option in the first-line treatment of EGFR mutation-positive advanced NSCLC. It is especially applicable to extend PFS and OS in OS-21 patients compared with EGFR-TKI alone.