Factor associated with failure to administer subsequent treatment after progression in the first-line chemotherapy in EGFR-mutant non-small cell lung cancer: Okayama Lung Cancer Study Group experience.
Factor associated with failure to administer subsequent treatment after progression in the first-line chemotherapy in EGFR-mutant non-small cell lung cancer: Okayama Lung Cancer Study Group experience.
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EGFR 突变非小细胞肺癌一线化疗进展后未能给予后续治疗的相关因素：冈山肺癌研究组的经验。
DOI：
10.1007/s00280-014-2425-9
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Kiura K.
中科院分区：
文献类型：
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作者：
Kato Y;Hotta K;Takigawa N;Nogami N;Kozuki T;Sato A;Ichihara E;Kudo K;Oze I;Tabata M;Shinkai T;Tanimoto M;Kiura K.
目的表皮生长因子受体-酪氨酸激酶抑制剂（EGFR- tki）单药治疗和细胞毒性化疗对EGFR突变的非小细胞肺癌（NSCLC）患者至关重要。我们调查了这些治疗的一线给药对NSCLC患者后续治疗的影响。方法本研究从2007年至2011年连续招募63例晚期egfr突变NSCLC患者，这些患者均接受了一线EGFR-TKI治疗或标准细胞毒化疗，然后病情进展。评估每位患者在一线治疗失败后接受其他治疗的能力。结果在一线治疗中，分别有23例和40例患者接受EGFR-TKI治疗和细胞毒性化疗。复发时，与细胞毒化疗组相比，EGFR-TKI治疗组出现更频繁的PS恶化（p= 0.042），症状性中枢神经系统（CNS）复发的可能性更大（p= 0.093）。最初接受EGFR-TKI治疗的23例患者中有9例（39%）在进展后无法接受标准的细胞毒治疗，主要原因是症状性中枢神经系统复发。最初接受细胞毒性化疗的40例患者中只有1例（3%）未能接受随后的EGFR-TKI治疗（p< 0.001）。多因素分析显示，一线治疗与疾病进展后未能切换到其他治疗之间存在相关性（OR 48.605,p= 0.005）。在本研究中，早期不能同时接受EGFR-TKI治疗和细胞毒性化疗的患者更多地纳入一线EGFR-TKI组，这表明错过后续治疗的给药时机存在潜在风险。进一步的研究是必要的，以检测他们的预处理临床或分子特征，以开发新的治疗策略，具体针对这些亚群。
PurposeEarly administration of both epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) monotherapy and cytotoxic chemotherapy is crucial for non-small cell lung cancer (NSCLC) patients harboring EGFR mutations. We investigated the effect of first-line administration of these therapies on subsequent therapy in NSCLC patients.MethodsThis study enrolled 63 consecutive patients with advanced EGFR-mutant NSCLC and good performance status (PS) and who underwent first-line EGFR-TKI therapy or standard cytotoxic chemotherapy and then had progressive disease, from 2007 to 2011. The ability of each patient to receive the other therapy after first-line treatment failure was assessed.ResultsIn the first-line setting, 23 and 40 patients received EGFR-TKI therapy and cytotoxic chemotherapy, respectively. At relapse, the EGFR-TKI therapy group showed more frequent PS deterioration (p= 0.042) and greater likelihood of symptomatic central nervous system (CNS) relapse (p= 0.093) compared with the cytotoxic chemotherapy group. Nine (39 %) of 23 patients initially receiving EGFR-TKI therapy could not receive standard cytotoxic therapy after progression mainly due to symptomatic CNS relapse. Only one (3 %) of 40 initially treated with cytotoxic chemotherapy failed to receive subsequent EGFR-TKI therapy (p< 0.001). Multivariate analysis revealed a correlation between the first-line therapy and the failure to switch to the other therapy after disease progression (OR 48.605,p= 0.005).ConclusionIn this study, patients who could not receive both EGFR-TKI therapy and cytotoxic chemotherapy in the early-line setting were included more in the first-line EGFR-TKI group, suggesting a potential risk associated with missing the timing of administration of subsequent therapy. Further investigation is warranted to detect their pretreatment clinical or molecular characteristics for development of a new treatment strategy specific for such subpopulation.