Effects of epidermal growth factor receptor-tyrosine kinase inhibitors alone on EGFR-mutant non-small cell lung cancer with brain metastasis.
Effects of epidermal growth factor receptor-tyrosine kinase inhibitors alone on EGFR-mutant non-small cell lung cancer with brain metastasis.
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DOI：
10.1111/1759-7714.12379
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发表时间：
2016-11
期刊：
影响因子：
2.9
通讯作者：
Zhou Q
中科院分区：
文献类型：
--
作者：
Zhang Q;Zhang X;Yan H;Jiang B;Xu C;Yang J;Chen Z;Su J;Wu YL;Zhou Q
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）对治疗EGFR突变型非小细胞肺癌（NSCLC）非常有效。然而，EGFR‐ TKI在EGFR突变型NSCLC脑转移（BM）患者中的个体作用尚不清楚。回顾性筛选了继发于NSCLC且携带EGFR激活突变的BM患者。接受吉非替尼或厄洛替尼控制颅外病变（ECL）和颅内病变（ICLs）的患者符合条件。如果ECL在ICL进展时保持稳定或缓解;无症状BM进展为症状性BM; BM症状在两周内未缓解;或BM症状在初始缓解后恶化，则患者接受脑放疗或其他局部治疗，并继续服用TKI直至ECL进展。在43例合格患者中，ICL的客观缓解率和疾病控制率分别为57%和91%。中位无进展生存期（PFS）为9.3个月。ICL和ECL的中位PFS分别为9.7和13.7个月。发现非吸烟者和二线TKI分别是PFS和总生存期（OS）的独立阳性预后因素，风险比为0.29（95%置信区间[CI] 0.14-0.61; P = 0.001）和0.34（95% CI 0.16-0.70; P = 0.003）。接受或未接受脑放疗的患者之间的中位OS无显著差异（23.6 vs. 18.7个月; P = 0.317）。 EGFR‐ TKI单药治疗EGFR‐突变型NSCLC引起的BM有效。TKI在ICL和ECL中的疗效应单独评价。
Epidermal growth factor receptor‐tyrosine kinase inhibitors (EGFR‐TKIs) are remarkably effective for treating EGFR‐mutant non‐small cell lung cancer (NSCLC). However, the individual role of EGFR‐TKIs in patients with brain metastasis (BM) arising from EGFR‐mutant NSCLC remains unclear. Patients with BM secondary to NSCLC and harboring EGFR‐activating mutations were retrospectively screened. Patients who received gefitinib or erlotinib to control both extracranial lesions (ECLs) and intracranial lesions (ICLs) were eligible. If ECLs remained stable or remissive while ICLs progressed; asymptomatic BM progressed to symptomatic BM; BM symptoms were not alleviated within two weeks; or BM symptoms deteriorated after initial release, patients received brain radiotherapy or other local treatments and continued taking TKIs until ECLs progression occurred. In 43 eligible patients, the objective response and disease control rates for ICLs were 57% and 91%, respectively. Median progression‐free survival (PFS) was 9.3 months. The median PFS for ICLs and ECLs was 9.7 and 13.7 months, respectively. Non‐smokers and second‐line TKIs were found to be independent positive prognostic factors for PFS and overall survival (OS) respectively, with a hazard ratio of 0.29 (95% confidence interval [CI] 0.14–0.61; P = 0.001) and 0.34 (95% CI 0.16–0.70; P = 0.003). No significant difference in median OS was observed between patients who did or did not receive brain radiotherapy (23.6 vs. 18.7 months; P = 0.317). EGFR‐TKIs alone are effective for treating BM arising from EGFR‐mutant NSCLC. The efficacy of TKIs in ICLs and ECLs should be evaluated separately.
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