国际肿瘤学杂志

国际肿瘤学杂志 ›› 2019, Vol. 46 ›› Issue (5): 257-261.doi: 10.3760/cma.j.issn.1673-422X.2019.05.001

• 论著 •    下一篇

厄洛替尼与替莫唑胺联合治疗全脑放疗后复发进展的EGFR基因突变的NSCLC脑转移的疗效观察

杨乔1，刘尧1，邱辉2，耿熠1，闫晓红1，侯杰1，崔翠花1，董龙科1   

  1. 1陕西省宝鸡市中心医院肿瘤内科721000； 2山东省新泰市人民医院肿瘤二科271200
  • 收稿日期:2018-10-15 出版日期:2019-05-08 发布日期:2019-06-14
  • 通讯作者: 刘尧 E-mail:baojiliuyao@163.com

Curative effect observation of erlotinib plus temozolomide for recurrence/progression in patients with EGFR gene mutation in NSCLC with brain metastases after whole brain radiotherapy

Yang Qiao1, Liu Yao1, Qiu Hui2, Geng Yi1, Yan Xiaohong1, Hou Jie1, Cui Cuihua1, Dong Longke1   

  1. 1Department of Medical Oncology, Baoji Central Hospital of Shaanxi Province, Baoji 721000, China; 2Second Department of Medical Oncology, Xintai People′s Hospital of Shandong Province, Xintai 271200, China
  • Received:2018-10-15 Online:2019-05-08 Published:2019-06-14
  • Contact: Liu Yao E-mail:baojiliuyao@163.com

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摘要： 目的  观察厄洛替尼与替莫唑胺联合治疗经全脑放疗后颅内复发进展的表皮生长因子受体（EGFR）基因突变的非小细胞肺癌（NSCLC）脑转移患者的临床疗效及安全性。方法  收集2013年8月至2018年6月陕西省宝鸡市中心医院及山东省新泰市人民医院收治的68例经全脑放疗后颅内复发进展的EGFR基因突变的NSCLC脑转移患者，采用随机数字表法随机分为厄洛替尼组和联合治疗组（厄洛替尼联合替莫唑胺）。厄洛替尼组（34例）给予厄洛替尼150 mg/d，口服，直到病情进展或不能耐受不良反应，联合治疗组（34例）给予厄洛替尼联合替莫唑胺150 mg/（m2·d），口服，第1～5天，28 d为一周期，替莫唑胺治疗共6周期。比较两组患者治疗效果、不良反应发生情况。结果  厄洛替尼组和联合治疗组的总有效率分别为11.8%（4/34）、32.4%（11/34），疾病控制率分别为35.3%（12/34）、64.7%（22/34），差异均有统计学意义（χ2=4.191，P=0.041，χ2=5.882，P=0.015）。厄洛替尼组和联合治疗组的中位无进展生存期分别为3.22个月、5.29个月，中位总生存期分别为5.60个月、7.90个月，差异均有统计学意义（χ2=9.269，P=0.002；χ2=11.005，P=0.001）。联合治疗组恶心呕吐发生率较厄洛替尼组显著增加［67.6%(23/34)∶14.7%(5/34)］，两组差异有统计学意义（χ2=19.671，P＜0.001），其余不良反应发生率差异均无统计学意义（均P＞0.05），两组患者均未出现Ⅲ度以上不良反应。结论  厄洛替尼与替莫唑胺两药联合治疗在经全脑放疗后颅内复发进展的EGFR基因突变的NSCLC脑转移患者中疗效更好，且不良反应轻微，患者耐受性好。

关键词: 癌, 非小细胞肺, 肿瘤转移, 放射疗法, 厄洛替尼, 替莫唑胺

Abstract: Objective  To observe the clinical efficacy and safety of erlotinib plus temozolomide for recurrence/progression patients with epidermal growth factor receptor (EGFR) gene mutation in nonsmall cell lung cancer (NSCLC) with brain metastases after whole brain radiotherapy. Methods  A total of 68 EGFR gene mutation NSCLC patients with brain metastases of intracranial recurrence/progression after whole brain radiotherapy were selected from August 2013 to June 2018 in Baoji Central Hospital of Shaanxi Province and Xintai People′s Hospital of Shandong Province. All the patients were randomly divided into erlotinib group and combined treatment group (erlotinib combined with temozolomide) using random number table method. The patients in erlotinib group (34 cases) were treated with oral erlotinib 150 mg/d until progression or unacceptable adverse reaction, and the patients in combined treatment group (34 cases) were given erlotinib and oral temozolomide 150 mg/(m2·d) for 1-5 day, every 28 days was a cycle, temozolamide for 6 cycles. Comparison was made on curative effects and occurrence condition of adverse reactions between the two groups. Results  The overall response rates in the erlotinib group and combined treatment group were 11.8% (4/34) and 32.4% (11/34) respectively, and the disease control rates in the two groups were 35.3% (12/34) and 64.7% (22/34) respectively, with significant differences (χ2=4.191, P=0.041; χ2=5.882, P=0.015). The median progression-free survival in the erlotinib group and combined treatment group were 3.22 months and 5.29 months respectively, and the median overall survival in the two groups were 5.60 months and 7.90 months respectively, with significant differences (χ2=9.269, P=0.002; χ2=11.005, P=0.001). The incidence of nausea and vomiting in combined treatment group was significantly higher than that in erlotinib group ［67.6% (23/34) vs. 14.7% (5/34)］, with a significant difference (χ2=19.671, P＜0.001), but there were no significant differences in the incidences of other adverse reactions (all P＞0.05). The patients in the two groups had no more than grade Ⅲ of adverse reactions. Conclusion  The curative effect of erlotinib combined with temozolomide is better in the treatment of recurrence/progression patients with EGFR gene mutation in NSCLC with brain metastases after whole brain radiotherapy, with mild adverse reactions and good patients′ tolerance.

Key words: Carcinoma, non-small-cell lung, Neoplasm metastasis, Radiotherapy, Erlotinib, Temozolomide