摘要：表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）获得性耐药是制约肺癌靶向治疗的瓶颈。中药配合EGFR-TKIs治疗肺癌源于临床，近年来在临床实践的基础上开展转化研究，探讨中药干预改善或逆转EGFR-TKIs获得性耐药成为研究的新靶点。本文综述了清热解毒、活血化瘀中药及基于扶正活血解毒治法的中药复方对EGFR-TKIs获得性耐药的影响与机制，提出中药的整体调节与靶向治疗有可能发挥协同作用，成为肺癌治疗的创新模式。

关键词：表皮生长因子受体酪氨酸激酶抑制剂；获得性耐药；中药；靶向治疗；综述

DOI：10.3969/j.issn.1005-5304.2016.03.038

中图分类号：R285.5 文献标识码：A 文章编号：1005-5304（2016）03-0126-04

Abstract：Acquired resistance of EGFR-TKIs has become the major limitation of the efficacy of targeted therapy for lung cancer. Lung cancer has been treated by traditional Chinese medicine （TCM） combined with EGFR-TKIs， which originated from clinic. In recent years， reversing research has been conducted based on clinic application to discuss TCM intervening， improving and reversing EGFR-TKIs acquired resistance becoming a novel target for research. This article reviewed mechanism and effects of TCM herbs and compounds with the efficacy of clearing away heat and toxic materials， promoting blood circulation to remove blood stasis strengthening the body resistance， and invigorating the circulation of blood， and proposed that the whole regulation and targeted therapy of TCM may carry out synergistic effect and become innovation treatment model for lung cancer.

Key words：EGFR-TKI； acquired resistance； traditional Chinese medicine； targeted therapy； review

原发性肺癌在恶性肿瘤中发病率和死亡率高居榜首。靶向治疗是肺癌研究的里程碑。表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）是目前应用最广泛、具有代表性的肺癌靶向药物，能够特异性地与细胞内表皮生长因子受体（EGFR）结合，阻断肿瘤生长信号通路，适用于EGFR基因19-21外显子突变阳性的非小细胞肺癌[1-2]。采用EGFR-TKIs治疗并临床获益患者，有70%在6～12个月后会出现肿瘤再次进展，导致治疗失败，其根本原因是因获得性耐药[3-4]。临床研究显示，中药配合EGFR-TKIs治疗肺癌，能一定程度延长患者疾病无进展生存期[5-7]。近年来，在临床实践的基础上开展转化研究，以探讨中医药干预改善或逆转EGFR-TKIs获得性耐药作用机制成为研究的新靶点。现将相关研究进展介绍如下。

1 清热解毒中药

大黄具有清热解毒、泻下攻积、凉血通经功效。大黄素是从大黄中提取的单体。……