目的 對(duì)比阿法替尼與埃克替尼聯(lián)合TP化療治療晚期表皮生長(zhǎng)因子受體(EGFR)突變型非小細(xì)胞肺癌(NSCLC)的療效。方法 選取2018年4月-2021年10月河北北方學(xué)院附屬第一醫(yī)院收治78例晚期EGFR突變NSCLC患者,采用隨機(jī)數(shù)字法將所有患者分為對(duì)照組和治療組,每組各39例。兩組均給予紫杉醇聯(lián)合順鉑(TP)化療方案,對(duì)照組口服鹽酸?？颂婺崞?125 mg/次,3次/d。治療組餐后3h口服馬來(lái)酸阿法替尼片,40 mg/次,1次/d。兩組均治療3個(gè)月。觀察兩組患者臨床療效,比較治療前后兩組患者肺癌標(biāo)志物癌胚抗原(CEA)和細(xì)胞角蛋白21-1片段(CYFRA21-1)水平,及循環(huán)ctDNA豐度、表皮生長(zhǎng)因子受體(EGFR)、人表皮生長(zhǎng)因子受體-2(HER-2)水平。結(jié)果 治療組控制率(100.00%)與對(duì)照組(92.31%)相比差異無(wú)統(tǒng)計(jì)學(xué)意義。治療1、3個(gè)月后,兩組CEA、CYFRA21-1水平明顯低于治療前(P<0.05),同組治療3個(gè)月水平明顯低于治療1個(gè)月(P<0.05);且治療組血清CEA、CYFRA21-1水平明顯低于同期對(duì)照組(P<0.05)。治療1、3個(gè)月,同組循環(huán)ctDNA豐度、EGFR、HER-2水平明顯低于治療前(P<0.05),治療3個(gè)月明顯低于治療1個(gè)月(P<0.05),且治療組循環(huán)ctDNA豐度、EGFR、HER-2水平低于同期對(duì)照組(P<0.05)。結(jié)論 阿法替尼聯(lián)合TP化療治療晚期EGFR突變NSCLC的療效顯著,能進(jìn)一步降低循環(huán)ctDNA豐度、EGFR、HER-2水平,提高治療效果,安全性高。

Objective To compare the efficacy of alphatinib and ectini combined with TP chemotherapy in adjuvant treatment of advanced epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC). Methods Patients (78 cases) with EGFR mutant NSCLC in the First Affiliated Hospital of Hebei North University from April 2018 to October 2021 were divided into control and treatment group according to random number method, and each group had 39 cases. Patients in two groups were treated with TP chemotherapy. Patients in the control group were po administered with Icotinib Hydrochloride Tablets, 125 mg/time, three times daily. Patients in the treatment group po administered with Alfatinib Maleate Tablets 3 h after meals, 40 mg/time, once daily. Patients in two groups were treated for 3 months. After treatment, the clinical evaluation was evaluated, the lung cancer markers CEA and CYFRA21-1 levels, and circulating ctDNA abundance, EGFR, and HER-2 levels in two groups before and after treatment were compared. Results There was no significant difference in the control rate between the treatment group (100.00%) and the control group (92.31%). After 1 and 3 months of treatment, the levels of CEA and CYFRA21-1 in two groups were significantly lower than those before treatment (P＜0.05), the level of treatment for 3 months in the same group was significantly lower than that of treatment for1 month (P＜0.05), and the levels of serum CEA and CYFRA21-1 in the treatment group were significantly lower than those in the control group (P＜0.05). After 1 and 3 months of treatment, the levels of circulating ctDNA, EGFR and HER-2 in the same group were significantly lower than those before treatment (P＜0.05), the level of treatment for 3 months in the same group was significantly lower than that of treatment for1 month (P＜0.05), and the levels of circulating ctDNA, EGFR and HER-2 in the treatment group were lower than those in the control group (P＜0.05). Conclusion Afatinib combined with TP chemotherapy is effective in the treatment of advanced EGFR mutant NSCLC, which can further reduce the abundance of circulating ctDNA, the level of EGFR and HER-2, and improve the therapeutic effect with high safety.

R914

河北省醫(yī)學(xué)科學(xué)研究課題(20211359);張家口市市級(jí)科技計(jì)劃項(xiàng)目(2021072D)