国际肿瘤学杂志

国际肿瘤学杂志 ›› 2026, Vol. 53 ›› Issue (4): 201-206.doi: 10.3760/cma.j.cn371439-20251015-00033

• 论著 • 上一篇    下一篇

EGFR突变晚期NSCLC患者第三代EGFR-TKI治疗进展后不同治疗模式疗效的真实世界研究

杨俊玲1, 张桂芳2(), 慕竹青2, 黄普超2, 马晓艳2, 梁嘉欣2   

  1. 1 河南医药大学第四临床学院， 新乡 453000
    2 河南省新乡市中心医院肿瘤内二科， 新乡 453000
  • 收稿日期:2025-10-15 出版日期:2026-04-08 发布日期:2026-04-01
  • 通讯作者: 张桂芳，Email： xxchzhangguifang@126.com

Efficacy of different treatment modalities in the real-world setting for advanced EGFR-mutant NSCLC patients after progression on third-generation EGFR-TKI treatment

Yang Junling1, Zhang Guifang2(), Mu Zhuqing2, Huang Puchao2, Ma Xiaoyan2, Liang Jiaxin2   

  1. 1 Fourth Clinical College of Henan Medical University， Xinxiang 453000， China
    2 Second Department of Oncology， Xinxiang Central Hospital of Henan Province， Xinxiang 453000， China
  • Received:2025-10-15 Online:2026-04-08 Published:2026-04-01
  • Contact: Zhang Guifang， Email： xxchzhangguifang@126.com

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摘要：

目的 探讨表皮生长因子受体（EGFR）突变晚期非小细胞肺癌（NSCLC）患者第三代EGFR-酪氨酸激酶抑制剂（TKI）治疗进展后不同治疗模式在真实世界中的疗效。方法 回顾性分析2021年1月1日至2024年6月30日河南省新乡市中心医院收治的104例应用第三代EGFR-TKI治疗进展的晚期NSCLC患者的临床资料。根据第三代EGFR-TKI治疗进展后的不同治疗方式分为持续第三代EGFR-TKI治疗组（A组，n=44）和停止第三代EGFR-TKI的其他治疗组（B组，n=60）。比较两组客观缓解率（ORR）、疾病控制率（DCR）和中位无进展生存期（mPFS）。比较寡进展、广泛进展、脑转移患者中两种治疗方式的mPFS。采用Kaplan-Meier法进行生存分析。观察比较两组不良反应。结果 A组、B组ORR分别为20.45%（9/44）、13.33%（8/60），DCR分别为88.64%（39/44）、80.00%（48/60），差异均无统计学意义（χ2=0.94，P=0.332；χ2=1.39，P=0.239）。A组和B组患者的mPFS分别为8.3、6.0个月，差异有统计学意义（χ2=8.58，P=0.003）。亚组分析显示，寡进展患者中A组（n=18）和B组（n=14）的mPFS分别为8.2、6.8个月，广泛进展患者中A组（n=26）和B组（n=46）的mPFS分别为8.4、6.0个月，脑转移患者中A组（n=27）和B组（n=32）的mPFS分别为8.4、6.0个月，差异均有统计学意义（χ2=4.03，P=0.045；χ2=4.51，P=0.034；χ2=8.05，P=0.005）。安全性方面，A组、B组≥3级不良反应发生率分别为25.00%（11/44）、16.67%（10/60），差异无统计学意义（χ2 =1.09，P=0.296）；两组患者不良反应经对症处理后症状均得到缓解，未发生因不可耐受不良反应而停药情况。结论 EGFR突变晚期NSCLC患者第三代EGFR-TKI治疗进展后，持续第三代EGFR-TKI治疗较停止第三代EGFR-TKI的其他治疗模式mPFS显著延长，但两种治疗模式的ORR、DCR、安全性无明显差异。

关键词: 癌, 非小细胞肺, 基因, erbB-1, 受体蛋白质酪氨酸激酶类, 治疗结果

Abstract:

Objective To investigate the efficacy of different treatment modalities in the real-world setting for patients with advanced epidermal growth factor receptor （EGFR） mutant non-small cell lung cancer （NSCLC） after progression on third-generation EGFR-tyrosine kinase inhibitor （TKI） treatment. Methods A retrospective analysis was performed on the clinical data of 104 patients with advanced NSCLC who received third-generation EGFR-TKI treatment at Xinxiang Central Hospital of Henan Province between January 1， 2021， and June 30， 2024. Based on the different treatment approaches after the progression of third-generation EGFR-TKI treatment， patients were divided into two groups： Group A （n=44） continued to receive third-generation EGFR-TKI treatment， whereas Group B （n=60） discontinued it and received other therapeutic regimens. The objective response rate （ORR）， disease control rate （DCR） and median progression-free survival （mPFS） were compared between the groups. The mPFS of the two treatment approaches in patients with oligoprogression， widespread progression， and brain metastases were compared. Survival analysis was conducted using Kaplan-Meier method. The adverse reactions were observed and compared between the two groups. Results The ORR in Group A and Group B were 20.45% （9/44） and 13.33% （8/60） respectively， and the DCR were 88.64% （39/44） and 80.00% （48/60） respectively， with no statistically significant differences （χ²=0.94， P=0.332； χ²=1.39， P=0.239）. The mPFS of patients in Group A and Group B were 8.3 and 6.0 months respectively， with a statistically significant difference （χ²=8.58， P=0.003）. Subgroup analysis showed that the mPFS in oligoprogression patients were 8.2 and 6.8 months in Group A （n=18） and Group B （n=14）， respectively； in patients with widespread progression， it was 8.4 months in Group A （n=26） and 6.0 months in Group B （n=46）， respectively； in patients with brain metastases， it was 8.4 months in Group A （n=27） and 6.0 months in Group B （n=32）， with statistically significant differences （χ²=4.03， P=0.045； χ²=4.51， P=0.034； χ²=8.05， P=0.005）. In terms of safety， the incidence rates of grade ≥3 adverse reactions in Group A and Group B were 25.00% （11/44） and 16.67% （10/60）， respectively， with no statistically significant difference （χ²=1.09， P=0.296）. All adverse reactions in both groups were relieved after symptomatic treatment， and no cases of drug discontinuation due to intolerable adverse reactions occurred. Conclusions For advanced EGFR-mutant NSCLC patients after progression on third-generation EGFR-TKI treatment， continued treatment with the EGFR-TKIs significantly prolongs mPFS compared to other therapeutic regimens that discontinue the EGFR-TKIs. However， no significant differences are observed in the ORR， DCR and safety between the two treatment approaches.

Key words: Carcinoma, non-small-cell lung, Genes, erbB-1, Receptor protein-tyrosine kinases, Treatment outcome