王文彬

【摘要】 目的：探討吉非替尼联合培美曲塞治疗表皮生长因子受体-酪氨酸激酶抑制剂（EGFR-TKI）耐药的晚期非小细胞肺癌（NSCLC）的临床效果。方法：回顾性分析78例EGFR-TKI耐药的晚期NSCLC患者，40例接受吉非替尼联合培美曲塞治疗纳入观察组，38例接受培美曲塞治疗纳入对照组。比较两组患者的临床疗效、药物不良反应及存活率。结果：观察组客观缓解率和疾病控制率分别为52.50%、77.50%，高于对照组的28.95%和52.63%，差异有统计学意义（P<0.05）。观察组白细胞减少、血小板下降、皮疹发生率均高于对照组，差异均有统计学意义（P<0.05）。两组胃肠道反应、脱发发生率比较，差异无统计学意义（P>0.05）。观察组半年生存率为67.50%，高于对照组的44.74%，差异均有统计学意义（P<0.05）。观察组总生存期3～11个月，中位生存期7.5个月;对照组总生存期2.5～9个月，中位生存期5个月。观察组累积生存率高于对照组，差异有统计学意义（P<0.05）。结论：晚期NSCLC患者发生EGFR-TKI耐药后，使用吉非替尼联合培美曲塞治疗，相比培美曲塞单一治疗，可以有效缓解和控制病情，延长患者生存期，不良反应可耐受。

【关键词】 非小细胞肺癌; 表皮生长因子受体-酪氨酸激酶抑制剂; 吉非替尼; 培美曲塞

doi：10.14033/j.cnki.cfmr.2019.21.013 文献标识码 B 文章编号 1674-6805（2019）21-00-03

Effects of Gefitinib Combined with Pemetrexed on EGFR-TKI-resistant NSCLC/WANG Wenbin.//Chinese and Foreign Medical Research，2019，17（21）：-34

【Abstract】 Objective：To explore the clinical efficacy of gefitinib combined with pemetrexed in the treatment of advanced non-small cell lung cancer（NSCLC） with epidermal growth factor receptor-tyrosine kinase inhibitor（EGFR-TKI） resistance.Method：A total of 78 patients with advanced EGFR-TKI-resistant NSCLC were retrospectively analyzed.40 patients with gefitinib and pemetrexed were included in observation group，and 38 patients with pemetrexed were enrolled in control group.The clinical efficacy，adverse drug reactions and survival rate were compared between the two groups.Result：The objective remission rate and disease control rate in the observation group were 52.50% and 77.50% respectively，which were significantly higher than 28.95% and 52.63% in the control group（P<0.05）.The incidence rates of leukopenia，thrombocytopenia and rash in observation group were higher than those in control group（P<0.05）.There were no significant differences in the incidence rates of gastrointestinal reactions and alopecia between the two groups（P>0.05）.The half-year survival rate in observation group was 67.50%，higher than 44.74% in control group（P<0.05）.The overall survival time in observation group was 3 to 11 months，and the median survival time was 7.5 months.The overall survival time in control group was 2.5 to 9 months，and the median survival time was 5 months.The cumulative survival rate in observation group was greater than that in control group（P<0.05）.Conclusion：After EGFR-TKI resistance in patients with advanced NSCLC，gefitinib combined with pemetrexed can effectively alleviate and control the disease and prolong the survival time of patients with tolerable adverse reactions compared with pemetrexed monotherapy.

【Key words】 Non-small cell lung cancer; Epidermal growth factor receptor-tyrosine kinase inhibitor; Gefitinib; Pemetrexed

First-authors address：Huanggang Hospital of Traditional Chinese Medicine，Huanggang 438000，China

非小细胞肺癌（non-small cell lung cancer，NSCLC）早期症状隐匿，75%患者就诊时已处于中晚期，出现淋巴转移[1]。该病预后较差，只能通过化疗延长患者生存期、改善生活质量。表皮生长因子受体-酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosinekinase inhibitor，EGFR-TKI）作为靶向治疗药物，是NSCLC的主要化疗方案，但临床上普遍发现化疗1年左右患者会出现耐药性[2]，影响化疗效果。本研究将吉非替尼联合培美曲塞方案应用于EGFR-TKI耐药的NSCLC患者，探讨其临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

选取笔者所在医院2016年1月-2018年6月收治的EGFR-TKI耐药的晚期NSCLC患者78例为研究对象。纳入标准：符合NSCLC诊断标准[3-4]，经支气管镜病理学检查、细胞学检查诊断为NSCLC;肺癌晚期，TNM分期为ⅢA～Ⅳ期;首次于笔者所在医院就诊;初始NSCLC突变阳性;既往接受EGFR-TKI治疗（吉非替尼或厄洛替尼）后产生耐药性;患者活动状态ECOG-ZPS评分≤2分，日常生活活动能力……