阿美替尼联合信迪利单抗对TKI治疗后进展EGFR T790M突变阳性晚期肺癌的疗效分析

Clinical effect of almonertinib combined with sintilimab in treatment of advanced EGFR T790M mutation-positive lung cancer after progression on TKI therapy

摘要:

目的 探讨阿美替尼联合信迪利单抗对酪氨酸激酶抑制剂（TKI）治疗后进展表皮生长因子（EGFR）T790M突变阳性晚期肺癌的临床疗效。方法 回顾性分析2022年1月—2022年12月联勤保障部队第901医院收治的95例TKI治疗后进展EGFR T790M突变阳性患者的病历资料，以不同治疗方法将患者分为对照组（47例）、观察组（48例）。对照组接受阿美替尼治疗，观察组在对照组基础上接受信迪利单抗治疗。对比两组临床疗效、肿瘤标志物、细胞因子、免疫功能、不良反应及总生存期。结果 观察组的疾病控制率及客观缓解率均高于对照组（P <0.05）。观察组治疗前后细胞角蛋白19片段21-1片段、糖类抗原125水平的差值均大于对照组（P <0.05）。观察组治疗前后血管内皮生长因子、碱性成纤维细胞生长因子水平的差值均大于对照组（P <0.05）。观察组治疗前后自然杀伤细胞、CD4⁺和CD8⁺水平的差值均大于对照组（P <0.05）。两组患者不良反应总发生率比较，差异无统计学意义（P >0.05）。观察组生存率高于对照组（P <0.05）。结论 阿美替尼联合信迪利单抗治疗TKI治疗后进展EGFR T790M突变阳性晚期肺癌疗效确切，可改善患者免疫功能，调节细胞因子，降低肿瘤标志物水平，安全可靠，且可延长生存期。

Abstract:

Objective To explore the clinical effect of almonertinib combined with sintilimab in treatment of advanced epidermal growth factor receptor (EGFR) T790M mutation-positive lung cancer after progression on tyrosine kinase inhibitor (TKI) therapy.Methods The medical records of 95 patients with EGFR T790M mutation-positive lung cancer after progression on TKI therapy admitted to our hospital from January 2022 to December 2022 were retrospectively analyzed. They were divided into a control group (47 cases) and an observation group (48 cases) based on different treatment approaches. The control group received almonertinib, while the observation group received sintilimab in addition to almonertinib. The clinical effect, tumor markers, cytokines, immune function, adverse reactions, and overall survival (OS) were compared between the two groups.Results The disease control rate and objective response rate of the observation group were both higher than those of the control group (P < 0.05). The differences of the levels of cytokeratin 19 fragment 21-1 (CYFRA21-1) and carbohydrate antigen 125 (CA125) before and after treatment in the observation group were both higher than those in the control group (P < 0.05). The differences of the levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) before and after treatment in the observation group were both higher than those in the control group (P < 0.05). The differences of the levels of natural killer (NK), CD4⁺ and CD8⁺ cells before and after treatment in the observation group were all higher than those in the control group (P < 0.05). There was no statistically significant difference in the overall incidence of adverse reactions between the control group and the observation group (P > 0.05). The survival rate of the observation group was higher than that of the control group (P < 0.05).Conclusion Almonertinib combined with sintilimab is effective in the treatment of advanced lung cancer with EGFR T790M mutation after progression on TKI therapy. It enhances immune function, regulates cytokine profiles, decreases tumor marker levels, demonstrates good safety, and prolongs patient survival.