CAJ | 학술논문

　　背景与目的：对于(epidermal growth factor receptor tyrosine kinase inhibitor，EGFR-TKI)治疗失败的非小细胞肺癌(non-small cell lung cancer，NSCLC)患者亟需探索新的治疗策略来延缓或克服EGFR-TKI的获得性耐药。本研究旨在比较对此类患者采用化疗联合EGFR-TKI与单化疗的疗效及不良反应。方法：符合入组标准的18例患者中，8例接受化疗联合EGFR-TKI(CE组)，10例接受单化疗(C组)，21 d为1个周期，至少完成2个周期化疗的患者进行疗效及不良反应评价。结果：18例患者均可评价疗效，其中CE组客观反应率(objective response rate，ORR)为25%，C组ORR为10%，两组比较差异无统计学意义(P=0.832)；CE组疾病控制率(disease control rate，DCR)为87.5%，中位无进展生存期(progression free survival，PFS)为3.5个月，C组DCR为30%，中位PFS为2.4个月，两组比较差异有统计学意义(P=0.046，P=0.05)。CE组皮疹发生率高于C组(75％ vs 10％)，两组Ⅲ、Ⅳ度不良反应的差异均无统计学意义(P>0.05)。结论：EGFR突变阳性的NSCLC患者，在EGFR-TKI耐药后继续使用EGFR-TKI并联用化疗可延缓疾病进展，是EGFR-TKI治疗失败的NSCLC患者的一项治疗策略。
　　배경여목적：대우(epidermal growth factor receptor tyrosine kinase inhibitor，EGFR-TKI)치료실패적비소세포폐암(non-small cell lung cancer，NSCLC)환자극수탐색신적치료책략래연완혹극복EGFR-TKI적획득성내약。본연구지재비교대차류환자채용화료연합EGFR-TKI여단화료적료효급불량반응。방법：부합입조표준적18례환자중，8례접수화료연합EGFR-TKI(CE조)，10례접수단화료(C조)，21 d위1개주기，지소완성2개주기화료적환자진행료효급불량반응평개。결과：18례환자균가평개료효，기중CE조객관반응솔(objective response rate，ORR)위25%，C조ORR위10%，량조비교차이무통계학의의(P=0.832)；CE조질병공제솔(disease control rate，DCR)위87.5%，중위무진전생존기(progression free survival，PFS)위3.5개월，C조DCR위30%，중위PFS위2.4개월，량조비교차이유통계학의의(P=0.046，P=0.05)。CE조피진발생솔고우C조(75％ vs 10％)，량조Ⅲ、Ⅳ도불량반응적차이균무통계학의의(P>0.05)。결론：EGFR돌변양성적NSCLC환자，재EGFR-TKI내약후계속사용EGFR-TKI병련용화료가연완질병진전，시EGFR-TKI치료실패적NSCLC환자적일항치료책략。
Background and purpose:New treatment strategies should be explored for non-small cell lung cancer (NSCLC) patients after the failure of the epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). To compare the efficacy and toxicities of chemotherapy in combination with EGFR-TKI or single chemotherapy in advanced NSCLC patients with EGFR-TKI resistence. Methods:In this study, 18 patients were enrolled. Eight patients were treated by chemotherapy combined with EGFR-TKI (CE group);10 patients were treated by single chemotherapy (E group), 21 days for one cycle. All patients received at least 2 cycles of treatment. Results:All 18 patients had been evaluated. The CE group was similar to the E group in objective response rate (ORR:25%vs 10%, P=0.832). The CE group was higher than the E group in disease control rate (DCR:87.5%vs 30%, P=0.046). The median PFS was longer in CE group (3.5 months vs 2.4 months, P=0.05). The CE group was higher than the E group in rash (75%vs 10%, P<0.05). The grade 3-4 toxicities did not have significantly differences between the two groups (P>0.05). Conclusion:Though there was no significant difference in ORR between the 2 groups (P>0.05), the CE group was superior to the E group in DCR and PFS. Patients with retreatment of advanced NSCLC after the failure of EGFR-TKI can be controlled by continued EGFR-TKI and chemotherapy.