EGFR TKIs plus WBRT Demonstrated No Survival Benefit Other Than That of TKIs Alone in Patients with NSCLC and EGFR Mutation and Brain Metastases
EGFR TKIs plus WBRT Demonstrated No Survival Benefit Other Than That of TKIs Alone in Patients with NSCLC and EGFR Mutation and Brain Metastases
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对于 NSCLC 和 EGFR 突变和脑转移患者，EGFR TKI 联合 WBRT 与单独使用 TKI 相比没有任何生存获益
DOI：
10.1016/j.jtho.2016.05.013
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发表时间：
2016-10-01
影响因子：
20.4
通讯作者：
Zhang, Jun
中科院分区：
文献类型：
--
作者：
Jiang, Tao;Su, Chunxia;Zhang, Jun
简介：EGFR酪氨酸激酶抑制剂（TKI）联合全脑放疗（WBRT）是否能改善EGFR突变伴脑转移（BM）的NSCLC患者的生存率，目前尚不清楚。在该组中，116例患者单独接受EGFR TKI治疗（91例作为一线治疗），51例患者接受EGFR TKI + WBRT治疗30例作为一线治疗。与单独使用TKI相比，EGFR TKI联合WBRT无上级颅内无进展生存期（PFS）（6.9 vs 7.4个月[p = 0.232]）和全身PFS（7.5 vs 7.9个月[p = 0.546]），但与EGFR突变和BM的NSCLC的总生存期（OS）（21.6 vs 26.4个月[p = 0.049]）较差相关。在EGFR状态未知或野生型患者中，化疗+WBRT的颅内PFS（5.2 vs 5.9个月[p = 0.339]）和OS（10.5 vs 11.0个月[p = 0.977]）与单独化疗相似。在多因素分析中，EGFR突变是BM的独立危险因素（风险比= 1.476，p = 0.039），也是BM NSCLC患者OS的重要独立预后因素（风险比= 0.601，p = 0.028）。在EGFR突变型NSCLC伴BM患者中，EGFR TKI联合WBRT的生存获益似乎并不优于EGFR TKI单药治疗的生存获益上级。WBRT也没有给BM和EGFR野生型或未知状态的患者带来额外的化疗获益。(C)2016年国际肺癌研究协会。爱思唯尔公司出版All rights reserved.
Introduction: Whether EGFR tyrosine kinase inhibitors (TKIs) plus whole brain radiation therapy (WBRT) provide a better survival benefit than EGFR TKIs alone remains undetermined in patients with NSCLC with EGFR mutation and brain metastases (BMs).Methods: A total of 230 patients with NSCLC with EGFR mutation and BM were identified. Within this group, 116 patients received EGFR TKIs alone (as first-line therapy in 91 cases) and 51 patients received EGFR TKIs plus WBRT therapy (as first-line treatment in 30 cases).Results: Compared with TKIs alone, EGFR TKIs plus WBRT had no superior intracranial progression-free survival (PFS) (6.9 versus 7.4 months [p = 0.232)) and systemic PFS (7.5 versus 7.9 months [p = 0.546]) but were associated with worse overall survival (OS) (21.6 versus 26.4 months [p = 0.049]) in NSCLC with EGFR mutation and BM. Chemotherapy plus WBRT was shown to have an intracranial PFS (5.2 versus 5.9 months [p = 0.339]) and OS (10.5 versus 11.0 months [p = 0.977]) similar to those with chemotherapy alone in patients with EGFR of unknown or wild type status. In multivariate analysis, EGFR mutation was found to be an independent risk factor for BM (hazard ratio = 1.476, p = 0.039) and also a significant independent prognostic factor for OS in patients with NSCLC with BM (hazard ratio = 0.601, p = 0.028).Conclusions: The addition of WBRT to EGFR TKIs did not appear to have survival benefit superior to that of EGFR TKIs alone in with EGFR-mutant NSCLC with BM. WBRT also did not bring additional benefit to chemotherapy in patients with BM and EGFR of wild-type or unknown status. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.