Background and objective: The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have been widely used in the treatment of the advanced non-small cell lung cancer (NSCLC), especially in the adenocarcinoma patients with activating EGFR mutations. But there is no published overview of the following treatment. This report through observing the efficacy, toxicity and overall survival of different treatments to the advanced NSCLC patients who had gradual progression after EGFR-TKIs, evaluates the influence of the continued treatment and switching chemotherapy.
Methods: Retrospective review is conducted on 32 cases of advanced NSCLC patients who experienced treatment failure of EGFR-TKIs. One group accepted the continued treatment and the other group accepted the switching chemotherapy.
Results: The median overall survival of the continued treatment group is 36.0 months. The respose rate of the switching chemotherapy group is 43.75%, and clinical benefit rate (complete and partial response and stable disease) is 87.5%. The median overall survival is 15.5 months. The main toxicities are nausea, vomiting and hematological toxicities.
Conclusion: For the advanced NSCLC patients who had gradual progression after EGFR-TKIs, the continued treatment is one of the acceptable choices.
背景与目的 表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor tyrosine kinase inhibitors, EGFR-TKIs）目前广泛应用于晚期非小细胞肺癌（non-small cell lung cancer, NSCLC），特别是存在表皮生长因子受体EGFR基因突变的肺腺癌患者。对于治疗后进展的患者，后续治疗未取得共识。本文总结EGFR-TKIs治疗后缓慢进展的晚期NSCLC患者接受不同后续治疗方法的近期疗效、毒性反应和总生存期，评价不同治疗方法的意义。方法 回顾性分析我院2003年9月-2011年12月期间32例接受EGFR-TKIs治疗后缓慢进展的晚期NSCLC患者，分别继续接受EGFR-TKIs治疗或化疗。结果 EGFR-TKIs维持治疗组患者的中位生存时间为36.0个月，在改行化疗的患者中，化疗有效率为43.75%，总的临床获益率（完全缓解+部分缓解+稳定）为87.5%。中位生存时间为15.5个月。主要的毒性反应为恶心呕吐等消化道反应和血液学毒性。结论 在EGFR-TKIs治疗后出现肿瘤缓慢进展的患者中，维持原EGFR-TKIs治疗是可行的选择。