盐酸厄洛替尼片及耐药后化疗联合贝伐珠单抗注射液治疗肺腺癌1例报告并文献复习

doi:10.13481/j.1671-587x.20170530

吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (05): 1019-1024.doi: 10.13481/j.1671-587x.20170530

盐酸厄洛替尼片及耐药后化疗联合贝伐珠单抗注射液治疗肺腺癌1例报告并文献复习

刘相良¹, 纪伟¹, 李理², 赵颖华¹, 贾琳¹, 万志强¹, 陈晓¹, 李薇¹

1. 吉林大学第一医院肿瘤中心, 吉林长春 130021;
2. 吉林大学中日联谊医院结直肠肛门外科, 吉林长春 130033

收稿日期:2016-12-01 出版日期:2017-09-28 发布日期:2017-09-29
通讯作者: 李薇,教授,博士研究生导师(Tel:0431-88782180,E-mail:ds9291@qq.com);陈晓,副教授,硕士研究生导师(Tel:0431-88782180,E-mail:297139732@qq.com) E-mail:ds9291@qq.com;297139732@qq.com
作者简介:刘相良(1991-),男,吉林省长春市人,在读医学硕士,主要从事肺癌基础和临床方面的研究。
基金资助:
国家自然科学基金资助课题（81071920）

Lung adenocarcinoma treated by Erlotinib HCL Tablets and chemotherapy combined with bevacizumab after drug resistance:A case report and literature review

LIU Xiangliang¹, JI Wei¹, LI Li², ZHAO Yinghua¹, JIA Lin¹, WANG Zhiqiang¹, CHEN Xiao¹, LI Wei¹

1. Center of Cancer, First Hospital, Jilin University, Changchun 130021, China;
2. Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China

Received:2016-12-01 Online:2017-09-28 Published:2017-09-29

摘要/Abstract

摘要： 目的：报告盐酸厄洛替尼片和耐药后化疗联合贝伐珠单抗注射液治疗表皮生长因子受体（EGFR）基因突变型Ⅳ期肺腺癌1例，并进行相关文献复习。方法：患者，女性，无吸烟史，行胸部CT、全身PET-CT及经皮肺穿刺病理检查诊断为右肺腺癌（cT3N2M1 Ⅳ期），肝脏转移癌及多发骨转移癌，EGFR基因突变型（19del）。患者经盐酸厄洛替尼片、注射用培美曲塞二钠联合注射用卡铂、注射用盐酸吉西他滨联合注射用顺铂、注射用紫杉醇（白蛋白结合型）单药及注射用紫杉醇（白蛋白结合型）联合贝伐珠单抗注射液共五线治疗后，总生存期（OS）达32个月。其中患者应用盐酸厄洛替尼片治疗阶段无病进展期（PFS）评定为10个月。患者后因肝脏转移灶压迫胆管致高胆红素血症（总胆红素304 μmol·L^-1，直接胆红素193 μmol·L^-1），经注射用紫杉醇（白蛋白结合型）联合贝伐珠单抗注射液治疗后肝脏转移灶缩小、胆红素水平下降并获得3个月PFS（总胆红素70 μmol·L^-1，直接胆红素35 μmol·L^-1），后胆红素水平回升且症状持续加重，总胆红素最高达908 μmol·L^-1。患者行胆囊穿刺置管引流术无效，总胆红素最高可达908 μmol·L^-1，因无法纠正的高胆红素血症最终临床死亡。结果：EGFR突变型Ⅳ期肺腺癌患者应用盐酸厄洛替尼片治疗获得10个月PFS，约占1/3的OS。耐药后进行多线化疗并发高胆红素血症，应用化疗联合贝伐珠单抗注射液为五线治疗方案，患者胆红素水平下降并获得3个月PFS。结论：EGFR酪氨酸激酶抑制剂（EGFR-TKIs）治疗EGFR基因突变型肺腺癌患者效果良好；VEGF靶向药物贝伐珠单抗注射液抑制肿瘤血管生成，在肿瘤耐药后仍然取得较好临床疗效；可将化疗联合贝伐珠单抗注射液作为五线化疗方案治疗肺腺癌肝转移所致的高胆红素血症。

关键词: 表皮生长因子受体, 肺肿瘤, 盐酸厄洛替尼片, 贝伐珠单抗注射液, 胆红素

Abstract: Objective: To report a case of lung adenocarcinoma of stage Ⅳ with epidermal growth factor receptor(EGFR) mutation treated by Erlotinib HCL Tablets and chemotherapy combined with bevacizumab after drug resistance, and to review the related literatures. Methods: A female patient without smoking history was diagnosed with lung adenocarcinoma (stagecT3N2M1 Ⅳ) with metastatic lesions in liver and bones by chest CT, lung puncture biopsy,and whole-body PET-CT. EGFR gene test reported mutation (19 del). Through treatment of overall survival, pemetrexed disodium for injection plus carboplatin injection, gemcitabine hydrochloride for injection plus cisplatin injection, paclitaxel for injection(albumin bound) single and with bevacizumab; the overall survival(OS) was assessed as 32 months. And the period of Erlotinib HCL Tablets showed 10 months of progressive-free survival(PFS). However, due to the metastatic lesions that suppressed biliary system in liver, hyperbilirubinemia emerged(total bilirubin 304 μmol·L^-1, direct bilirubin 193 μmol·L^-1). Bevacizumab was adopted and the syndrome relieved(total bilirubin 70 μmol·L^-1, direct bilirubin 35 μmol·L^-1), yielding three months of PFS. But the bilirubin level upgraded with total bilirubin of 908 μmol·L^-1. The patient died because of hyperbilirubinemia. Results: 10-month PFS occupied 1/3 of OS was acquired in the patients with EGFR-mutated lung adenocarcinoma(stage Ⅳ) after treated with Erlotinib HCL Tablets. Chemotherapy combined with bevacizumab acquired 3 months of PFS after hyperbilirubinemia emerged with drug resistance and multi-lines of chemotherapy. Conclusion: EGFR-TKIs are effective in treatment of lung adenocarcinoma with EGFR mutation; bevacizumab can inhibit the formation of vessels by targeting on VEGF under the circumstance of multiple drug resistance. Therefore, chemotherapy combined with bevacizumab can be used as the fifth-line of therapy in dealing with the hyperbilirubinemia induced by lung adenocarcinoma with liver metastasis.

Key words: epidermal growth factor receptor, lung neoplasms, Erlotinib HCL Tablets, bevacizumab, bilirubin

中图分类号:

R734.2

刘相良, 纪伟, 李理, 赵颖华, 贾琳, 万志强, 陈晓, 李薇. 盐酸厄洛替尼片及耐药后化疗联合贝伐珠单抗注射液治疗肺腺癌1例报告并文献复习[J]. 吉林大学学报(医学版), 2017, 43(05): 1019-1024.

LIU Xiangliang, JI Wei, LI Li, ZHAO Yinghua, JIA Lin, WANG Zhiqiang, CHEN Xiao, LI Wei. Lung adenocarcinoma treated by Erlotinib HCL Tablets and chemotherapy combined with bevacizumab after drug resistance:A case report and literature review[J]. Journal of Jilin University Medicine Edition, 2017, 43(05): 1019-1024.

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盐酸厄洛替尼片及耐药后化疗联合贝伐珠单抗注射液治疗肺腺癌1例报告并文献复习

Lung adenocarcinoma treated by Erlotinib HCL Tablets and chemotherapy combined with bevacizumab after drug resistance:A case report and literature review

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