盐酸埃克替尼片联合全脑放疗治疗非小细胞肺癌脑转移的临床效果

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摘要目的探讨盐酸埃克替尼片（凯美纳）联合放疗治疗晚期非小细胞肺癌脑转移的近期效果和安全性。方法回顾性分析2013年2月～2016年2月武汉大学人民医院收治的142例非小细胞肺癌脑转移患者的临床资料，根据治疗途径将其分为盐酸埃克替尼片联合全脑放疗组51例、盐酸埃克替尼片组51例和全脑放疗组40例。盐酸埃克替尼片联合全脑放疗组为全脑放疗同时口服盐酸埃克替尼片，放疗剂量为40～50 Gy/20～25 F，1个月内放疗完成，盐酸埃克替尼片为放疗开始时每天口服一片，剂量为125 mg，3次/d；盐酸埃克替尼片组为每天口服一片盐酸埃克替尼片，剂量为125 mg，3次/d；全脑放疗组放疗剂量为40～50 Gy/20～25 F，1个月内放疗完成。三组患者直至病情进展或出现不能耐受的毒性反应停止用药，从开始治疗至病情进展计算无进展生存时间。通过χ2检验分析三组患者客观有效率、疾病控制率及各项不良反应发生率是否有显著差异，通过Kaplan-Meier检验法分析三组患者无进展生存期是否有显著差异。结果盐酸埃克替尼片联合全脑放疗组客观有效率和疾病控制率高于盐酸埃克替尼片组与全脑放疗组，差异均有统计学意义（均P ＜ 0.05）。盐酸埃克替尼片组与全脑放疗组客观有效率和疾病控制率比较，差异无统计学意义（P ＞ 0.05）。盐酸埃克替尼片联合全脑放疗组的中位无进展生存时间高于盐酸埃克替尼片组和全脑放疗组，差异均有统计学意义（均P ＜ 0.05）；盐酸埃克替尼片组的无进展生存时间中位数与全脑放疗组比较，差异无统计学意义（P ＞ 0.05）。盐酸埃克替尼片联合全脑放疗组的1年生存率为66.7%，高于盐酸埃克替尼片组的41.2%和全脑放疗组的37.5%，差异均有统计学意义（均P ＜ 0.05）。三组患者各项不良反应发生率比较，差异无统计学意义（P ＞ 0.05）。结论盐酸埃克替尼片联合全脑放疗在不良反应可耐受的情况下可明显提高患者疾病控制率和无进展生存时间。

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	李文格戈伟

关键词 ：肺癌, 脑转移, 盐酸埃克替尼片, 靶向药物, 全脑放疗

Abstract：Objective To investigate the short-term efficacy and safety of Icotinib Hydrochloride Tablets (Conmana) combined with whole-brain radiotherapy in the treatment of advanced non-small cell lung cancer with brain metastasis. Methods The clinical data of 142 patients with non-small cell lung cancer with brain metastasis admitted to the Renmin Hospital of Wuhan University from February 2013 to February 2016 were retrospectively analyzed. According to the treatment approaches, they were divided into 51 cases in the group of Icotinib Hydrochloride Tablets combined with whole-brain radiotherapy, 51 cases in the group of Icotinib Hydrochloride Tablets and 40 cases in the group of whole-brain radiotherapy. In the Icotinib Hydrochloride Tablets combined with whole-brain radiotherapy group, whole-brain radiotherapy was performed simultaneously with oral administration of Icotinib Hydrochloride Tablets. The radiotherapy dose was 40-50 Gy/20-25 F, and the radiotherapy was completed within one month. Icotinib Hydrochloride Tablets were taken orally once a day at the beginning of radiotherapy, and the dose was 125 mg, 3 times a day. In the Icotinib Hydrochloride Tablets group, one Icotinib Hydrochloride Tablet was taken orally every day at a dose of 125 mg, 3 times a day. The whole-brain radiotherapy group received a radiotherapy dose of 40-50 Gy/20-25 F. The radiotherapy was completed within one month. In the three groups, the drug of parients was discontinued until the disease progressed or an intolerable toxic reaction occurred, and the progression-free survival time was calculated from the start of treatment until the disease progressed. Chi-square test was used to analyze whether there were significant differences in objective response rate, disease control rate and incidence of adverse reactions among the three groups of patients, and Kaplan-Meier test was used to analyze whether there were significant differences in progression-free survival among the three groups of patients. Results The objective response rate and disease control rate of Icotinib Hydrochloride Tablets combined with whole-brain radiotherapy group were higher than those of the Icotinib Hydrochloride Tablets group and the whole-brain radiotherapy group, the differences were statistically significant (all P ＜ 0.05). There was no significant difference in the objective response rate and disease control rate between the Icotinib Hydrochloride Tablets group and the whole-brain radiotherapy group (P ＞ 0.05). Median progression-free survival in the Icotinib Hydrochloride Tablets combined with whole-brain radiotherapy group was higher than that in the Icotinib Hydrochloride Tablets group and higher than that in the whole-brain radiotherapy group, the differences were statistically significant (all P ＜ 0.05). The median progression-free survival time of the Icotinib Hydrochloride Tablets group was not significantly different from that of the whole-brain radiotherapy group (P ＞ 0.05). The one-year survival rate of Icotinib Hydrochloride Tablets combined with whole-brain radiotherapy group was 66.7% higher than that of the Icotinib Hydrochloride Tablets group (41.2%) and the whole-brain radiotherapy group (37.5%), with statistically significant differences (all P ＜ 0.05). There was no significant difference in the incidence of adverse reactions among the three groups of parients (P ＞ 0.05). Conclusion Icotinib Hydrochloride Tablets combined with whole-brain radiotherapy can significantly improve the disease control rate and progression-free survival time of patients with tolerable adverse reactions.

Key words： Lung cancer Brain metastases Icotinib Hydrochloride Tablets Targeted drugs Whole-brain radiotherapy

基金资助:国家重点研发计划项目（2016YFC1303800）。

通讯作者: 戈伟（1960-），男，博士，主任医师，硕士生导师；研究方向：肿瘤靶向治疗，肿瘤微循环与放射性治疗，肿瘤综合诊治。

引用本文:

李文格戈伟. 盐酸埃克替尼片联合全脑放疗治疗非小细胞肺癌脑转移的临床效果[J]. 中国医药导报, 2020, 17(8): 101-105.
LI Wenge GE Wei. Clinical effect of Icotinib Hydrochloride Tablets combined with whole-brain radiotherapy in the treatment of brain metastasis of non-small cell lung cancer. 中国医药导报, 2020, 17(8): 101-105.

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