Combination therapy of brain radiotherapy and EGFR-TKIs is more effective than TKIs alone for EGFR-mutant lung adenocarcinoma patients with asymptomatic brain metastasis
Combination therapy of brain radiotherapy and EGFR-TKIs is more effective than TKIs alone for EGFR-mutant lung adenocarcinoma patients with asymptomatic brain metastasis
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DOI：
10.1186/s12885-019-6005-6
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发表时间：
2019-08-09
期刊：
影响因子：
3.8
通讯作者：
Liu, Anwen
中科院分区：
文献类型：
--
作者：
Chen, Yanxin;Wei, Jianping;Liu, Anwen
背景表皮生长因子受体（EGFR）突变型肺腺癌（LAC）患者脑转移（BM）的治疗策略仍存在争议。在本研究中，我们比较了脑放疗（RT）联合酪氨酸激酶抑制剂（TKI）和单独TKI治疗EGFR突变和BM的晚期LAC患者的疗效。方法回顾性分析78例EGFR突变型LAC患者的临床资料。这些患者分为两组：联合治疗组49例患者接受脑RT联合EGFR-TKI治疗（包括23例RT前无症状BM患者）; TKI组29例患者仅接受EGFR-TKI靶向治疗（包括22例TKI治疗前无症状BM患者）。结果联合治疗组的中位颅内无进展生存期（iPFS）较单用TKI组长（21.5 vs. 15个月; P = 0.036）。然而，两组之间的中位无进展生存期（PFS，12 vs. 13个月; P = 0.242）和中位总生存期（mOS，36 vs. 23个月; P = 0.363）无显著差异。对无症状BM的进一步分析显示，联合治疗组的中位iPFS和mOS均显著长于TKI单药治疗组（iPFS，21.5 vs. 14.8个月，P = 0.026; mOS，36 vs. 23个月，P = 0.041）。考克斯多变量回归分析未发现所有患者中iPFS的独立不良预测因素。结论脑RT和TKI同步联合治疗EGFR突变LAC伴BM患者上级单独使用EGFR TKI。联合治疗组表现出更长的iPFS，而两组之间的PFS和OS无显著差异。此外，联合治疗可在无症状BM患者中获得更好的iPFS和OS。因此，增加脑RT对颅内转移性病变是有用的。
Background The treatment strategy for brain metastasis (BM) in patients with epidermal growth factor receptor (EGFR) -mutant lung adenocarcinoma (LAC) remains controversial. In the present study, we compared the efficacy of brain radiotherapy (RT) in combination with tyrosine kinase inhibitors (TKIs) and TKIs alone for advanced LAC patients with EGFR mutations and BM. Methods We retrospectively studied 78 patients diagnosed with EGFR-mutant LAC who developed BM. These patients were divided into two groups: 49 patients in the combination treatment group who received brain RT in combination with EGFR-TKIs (including 23 patients with asymptomatic BM before RT); 29 patients in the TKI group who received EGFR-TKI targeted therapy alone (including 22 patients with asymptomatic BM before TKI treatment). Results The median intracranial progression-free survival (iPFS) of the combination treatment group was longer than that of the TKI alone group (21.5 vs. 15 months; P = 0.036). However, there were no significant differences in median progression-free survival (PFS, 12 vs. 13 months; P = 0.242) and median overall survival (mOS, 36 vs. 23 months; P = 0.363) between the two groups. Further analysis of asymptomatic BM showed that both the median iPFS and the mOS of the combination treatment group were significantly longer than for the TKI alone group (iPFS, 21.5 vs. 14.8 months, P = 0.026; mOS, 36 vs. 23 months, P = 0.041). Cox multivariate regression analysis found no independent adverse predictors of iPFS in all patients. Conclusions The synchronous combination of brain RT and TKIs was superior to EGFR-TKIs alone for EGFR-mutant LAC patients with BM. The combination treatment group exhibited longer iPFS, while the PFS and OS were not significantly different between the two groups. In addition, the combination treatment could result in better iPFS and OS in those with asymptomatic BM. Therefore, addition of brain RT was useful for intracranial metastatic lesions.