2.RECIST progression patterns during EGFR tyrosine kinase inhibitor treatment of advanced non-small cell lung cancer patients harboring an EGFR mutation.
2.RECIST progression patterns during EGFR tyrosine kinase inhibitor treatment of advanced non-small cell lung cancer patients harboring an EGFR mutation.
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2.EGFR酪氨酸激酶抑制剂治疗携带EGFR突变的晚期非小细胞肺癌患者期间的RECIST进展模式。
DOI：
10.1016/j.lungcan.2015.09.025
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发表时间：
2015
期刊：
影响因子：
5.3
通讯作者：
Tatsuya Yoshida
中科院分区：
文献类型：
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作者：
Yoshida T;Oya Y;Tanaka K;Shimizu J;Horio Y;Kuroda H;Sakao Y;Hida T;Yatabe Y.;Tatsuya Yoshida;Tatsuya Yoshida;Tatsuya Yoshida
背景表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗携带EGFR突变的晚期非小细胞肺癌（NSCLC）患者时，实体瘤进展性疾病（RECIST-PD）疗效评价标准的进展模式在临床上具有异质性。我们评估了EGFR-TKI治疗过程中的进展模式与此类患者治疗后预后之间的相关性。MethodsFrom 2008 to 2012，160例携带EGFR突变的晚期NSCLC患者接受了EGFR-TKI（厄洛替尼或吉非替尼）治疗。其中，104名经历RECIST-PD的患者回顾性评估了EGFR-TKI的初始反应，进展部位，进展病灶（孤立病灶或多病灶），RECIST-PD评估时的症状状态和进展后生存率（PPS）。EGFR-TKI的总体缓解率和至RECIST-PD的中位时间分别为68%和8.2个月。在达到RECIST-PD状态时，44例（42%）患者有症状，60例（58%）无症状。RECIST-PD时的进展部位为17例（16%）患者的孤立性脑病变和87例（84%）患者的全身性病变：24例（23%）为单发病变，80例（77%）为多发病变。在RECIST-PD评估后，40例（38%）患者继续使用EGFR-TKI，25例（24%）患者改用细胞毒性药物; 10例（10%）患者因孤立的进展部位接受局部放疗（脑6例;骨3例;肺1例）。中位PPS为10.8个月。多变量分析显示，无症状或孤立性病变状态与PPS显著延长相关（无症状：HR 0.36，95%CI 0.21- 0.62，P < 0.01;单发进展性病变：HR 0.45，95% CI 0.18-99，P= 0.04）。结论携带EGFR突变的晚期NSCLC患者在EGFR-TKI治疗期间的RECIST-PD进展模式多种多样，并可能与治疗失败后的临床结局相关。
BackgroundProgression patterns at the response evaluation criteria in solid tumors-progressive disease (RECIST-PD) during treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) for advanced non-small cell lung cancer (NSCLC) in patients harboring anEGFRmutation are clinically heterogeneous. We evaluated the association between progression patterns during EGFR-TKI treatment and prognosis after treatment in such patients.MethodsFrom 2008 to 2012, 160 consecutive patients with advanced NSCLC harboring anEGFRmutation were treated with EGFR-TKIs (erlotinib or gefitinib). Among these, 104 who experienced RECIST-PD were retrospectively evaluated for initial response to EGFR-TKIs, progression sites, focus of progression (solitary lesion or multiple lesions), symptom status at RECIST-PD evaluation, and post-progression survival (PPS).ResultsOf 104 patients, 96 (92%) had anEGFRmajor mutation, and 50 (48%) received EGFR-TKIs as first-line treatment. Overall response rate and median time to RECIST-PD on EGFR-TKIs were 68% and 8.2 months, respectively. At the time of attaining RECIST-PD status, 44 (42%) patients were symptomatic, and 60 (58%) were asymptomatic. Progression sites at RECIST-PD were isolated brain in 17 (16%) patients and systemic in 87 (84%): 24 (23%) had a solitary lesion, and 80 (77%) had multiple lesions. After RECIST-PD assessment, 40 (38%) patients continued EGFR-TKIs, and 25 (24%) switched to cytotoxic agents; 10 (10%) received local radiotherapy for an isolated progression site (brain 6; bone 3; lung 1). Median PPS was 10.8 months. Multivariate analysis revealed that asymptomatic or solitary lesion status was associated with significantly longer PPS (asymptomatic: HR 0.36, 95% CI 0.21–0.62,P< 0.01; solitary progression lesion: HR 0.45, 95% CI 0.18–99,P= 0.04).ConclusionsProgression patterns at the RECIST-PD during EGFR-TKI treatment of advanced NSCLC in patients harboring anEGFRmutation are widely diverse, and might be associated with clinical outcome after treatment failure.