CAJ | 학술논문

目的探讨吉非替尼和多西他赛用药的先后顺序对晚期非小细胞肺癌(NSCLC)患者二线治疗疗效的影响.方法回顾性分析中国医学科院肿瘤医院2002年4月至2007年1月期间接受吉非替尼和多西他赛交叉二线治疗的82例晚期NSCLC患者的临床资料.结果吉非替尼交叉到多西他赛(A组)17例,多西他赛交叉到吉非替尼(B组)65例.交叉前为第1阶段,交叉后为第2阶段.吉非替尼在第1、2阶段的有效率分别为29.4%和27.7%(P>0.05),多西他赛分别为13.8%和5.9%(P>0.05).对用药顺序进行统计学调整处理后吉非替尼的有效率为28.0%,明显优于多西他赛(12.2%,x2=5.46,P=0.02).吉非替尼治疗的中位至疾病进展时间为6.0个月,明显长于多西他赛的4.0个月(P=0.00).A、B组的中位生存时间分别为40.0和22.0个月,差异无统计学意义,但分层分析显示,体力状态差的患者先用吉非替尼较先用多西他赛生存期明显延长(中位生存时间分别为13.0和6.0个月,P=0.01).2种药物的不良反应均可耐受,不同用药顺序的不良反应发生率相似.结论吉非替尼和多西他赛的用药顺序对NSCLC患者的疗效和生存期无明显影响,但是一般情况较差的患者先用吉非替尼可能延长生存时间.
목적 탐토길비체니화다서타새용약적선후순서대만기비소세포폐암(NSCLC)환자이선치료료효적영향.방법 회고성분석중국의학과원종류의원2002년4월지2007년1월기간접수길비체니화다서타새교차이선치료적82례만기NSCLC환자적림상자료.결과 길비체니교차도다서타새(A조)17례,다서타새교차도길비체니(B조)65례.교차전위제1계단,교차후위제2계단.길비체니재제1、2계단적유효솔분별위29.4%화27.7%(P>0.05),다서타새분별위13.8%화5.9%(P>0.05).대용약순서진행통계학조정처리후길비체니적유효솔위28.0%,명현우우다서타새(12.2%,x2=5.46,P=0.02).길비체니치료적중위지질병진전시간위6.0개월,명현장우다서타새적4.0개월(P=0.00).A、B조적중위생존시간분별위40.0화22.0개월,차이무통계학의의,단분층분석현시,체력상태차적환자선용길비체니교선용다서타새생존기명현연장(중위생존시간분별위13.0화6.0개월,P=0.01).2충약물적불량반응균가내수,불동용약순서적불량반응발생솔상사.결론 길비체니화다서타새적용약순서대NSCLC환자적료효화생존기무명현영향,단시일반정황교차적환자선용길비체니가능연장생존시간.
Objective To evaluate the efficacy of sequential administration of gefitinib and docetaxel in the second-line therapy for advanced non-small cell lung cancer (NSCLC). Methods Eighty- two patients with advanced NSCLC who had received both gefitinib and docetaxel treatment were divided into 2 groups: Group A ( n = 17) that were treated with gefitinib first and then crossed over to docetaxel treatment when progressive disease (PD) occurred as second-line treatment, and Group B (n = 65) that were treated with docetaxel first, and then crossed over to gefitinib treatment when PD occurred. Results The response rate of gefitinib in phase Ⅰ ( duration before crossover) was 27.7%, not significantly different from that in phase Ⅱ (duration after crossover) (29.4%, P 0. 05). The response rate of docetaxel in phase Ⅰ was 13.8%, not significantly different from that in phase Ⅱ (5. 9%, P 0. 05 ). Gefitinib showed an efficacy superior to docetaxel after adjusting the sequence of these two agents (28.0% vs 12. 2%, x2 = 5.46, P = 0. 02). The time to progression (TTP) of gefitanib was 6. 0 months, signifieandy longer than that of docetaxol (4. 0 months, P =0. 00). Though no statistically significant survival difference was seen between these two groups, stratified analysis showed that the median survival time of the patients with the Eastern Cooperative Oncology Group (ECOG) = 2 in Group A was 13.0 months, significandy longer than that in Group B (6. 0 months, P = 0. 01 ). The adverse events (Aes), including skin rash and diarrhea were all generally tolerable. The incidence of Aes was similar in these two groups. Conclusion Although no impact was found in the efficacy and survival between these two different sequential administration of gefitinib and docetaxel for patients with advanced NSCLC, but the patients with poor performance status may get longer survival if they receive treatment of gefitinib first crossed-over to docetaxel.