对KI耐药的EGFR突变NSCLC治疗.ppt

继续吉非替尼治疗的患者生存情况更好 Continuing gefitinib was independently associated with a good survival based on multivariate analyses (hazard ratio (HR)=0.51; 95% confidence interval (CI)=0.26-0.98; p=0.0426), and performance status at the failure of gefitinib (0.05; 0.02-0.17; p0.0001). The adjusted HR of continuing gefitinib based on Cox regression analysis and a propensity score of 0.61 (95% CI, 0.41-0.92) indicated an association between a prolonged survival and the continuation of gefitinib. CONCLUSION: In addition to post gefitinib treatment, continuing the administration of gefitinib should be considered in patients who previously achieved disease control with gefitinib, even after a failure of gefitinib. * Between 2005 and 2008, 16 NSCLC patients, who had been previously treated with gefitinib and evaluated as partial response or complete response according to the response evaluation criteria in solid tumors (RECIST), received gefitinib plus paclitaxel. Paclitaxel was administered at 60 mg/m(2) on days 1, 8 and 15 every 4 weeks, and gefitinib was administered at 250 mg/day from the first day of administration of paclitaxel. RESULTS: The response rate and disease control rate were 13% and 75%, respectively. The median progression-free survival (PFS) and median overall survival were 4.3 months and 8.1 months, respectively. The toxicities were mild, and there were no treatment-related deaths. CONCLUSIONS: Gefitinib plus paclitaxel after failure of gefitinib exhibits activity and acceptable toxicity. * * * 发表于今年9月26号oncologist的回顾性分析 今年新版NCCN指南的推荐。对多处转移的耐药患者还是继续推荐化疗+TKI，我觉得这个还是存在很多争议的。刚刚9月份Oncologist发表了一篇回顾性分析，虽然例数不多，只有34例，但对比了耐药后的患者化疗+靶向 vs. 化疗，作者说这是进行这种比较的第一篇文章，结果联合治疗方案只有RR的获益而没有OS和PFS的获益。这个也是我昨天才看到的，（全文放附件了）所以我觉得耐药后的治疗真的还是有很多值得商榷的地方：什么时候停药？什么时候联合化疗继续使用？什么情况下可以TKI停药间歇化疗，再次进展后重新考虑TKI的治疗，这种标准的选择模式还是值得进一步探讨。 * 我们先看2篇回顾性分析。1、美国纽约一家医院的胸部肿瘤组回顾性分析了18例这些患者接受过非CNS的局部治疗，且EGFR突变肺癌患者对EGFR TKI治疗出现获得性耐药 这些患者此前接受了局部治疗（手术、射频消融、放疗）。局部治疗耐受性良好，85%的患者在局部治疗的1月内重新开始TKI治疗。局部治疗后的中位TTP为10个月。到后续系