Osimertinib Improves Overall Survival in Patients With EGFR-Mutated NSCLC With Leptomeningeal Metastases Regardless of T790M Mutational Status
Osimertinib Improves Overall Survival in Patients With EGFR-Mutated NSCLC With Leptomeningeal Metastases Regardless of T790M Mutational Status
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DOI：
10.1016/j.jtho.2020.06.018
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发表时间：
2020-11-01
影响因子：
20.4
通讯作者：
Ahn, Myung-Ju
中科院分区：
文献类型：
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作者：
Lee, Jiyun;Choi, Yoon La;Ahn, Myung-Ju
简介：奥希替尼是第三代EGFR酪氨酸激酶抑制剂，可有效穿透血脑屏障。本研究探讨了与未接受奥希替尼治疗的患者相比，奥希替尼治疗是否能改善EGFR突变NSCLC伴软脑膜转移（LM）患者的总生存期（OS）。方法：回顾性分析2008年10月至2019年10月期间，根据奥希替尼治疗和T790 M突变状态，对EGFR突变NSCLC伴细胞学确诊的LM患者的OS进行分析。结果：纳入分析的351例LM患者中，中位OS（mOS）为8.1个月（95%可信区间[CI]：7.2-9.0）。197例受试患者中有88例检测到T790 M突变，共有110例患者在LM后接受奥希替尼治疗。根据T790 M突变状态，mOS无差异（10.1个月[95% CI：4.31-15.82] vs 9.0 [95% CI：6.81-11.21]，p 1/4 0.936）。（95% CI：15.13-18.94）与未接受奥希替尼治疗的患者相比，其mOS为5.5个月（95% CI：4.34-6.63），无论T790 M突变状态如何（风险比：0.36 [95% CI：0.28- 0.47]，p < 0.001）。这也是相当长的时间，甚至比那些谁从来没有用奥希替尼治疗，但有第一或第二代EGFR酪氨酸激酶inhibitors.Conclusions的mOS的8.7个月（95%CI：7.01-10.39）奥希替尼是一个有前途的治疗选择EGFR突变的NSCLC与LM无论T790 M突变状态。(C)2020年国际肺癌研究协会。爱思唯尔公司出版All rights reserved.
Introduction: Osimertinib, a third-generation EGFR tyro-sine kinase inhibitor, efficiently penetrates the blood-brain barrier. This study explored whether treatment with osimertinib leads to improved overall survival (OS) for patients with EGFR-mutated NSCLC with leptomeningeal metastases (LM) compared with those not treated with osimertinib.Methods: From October 2008 to October 2019, patients with EGFR-mutated NSCLC and cytologically confirmed LM were retrospectively analyzed for OS according to osimertinib treatment and T790M mutational status. The OS was defined as the time from the diagnosis of LM to death.Results: For the 351 patients with LM included in the analysis, the median OS (mOS) was 8.1 months (95% confidence interval [CI]: 7.2-9.0). T790M mutation was detected in 88 of 197 patients tested, and a total of 110 patients were treated with osimertinib after LM. No difference in mOS according to T790M mutational status (10.1 mo [95% CI: 4.31-15.82] versus 9.0 [95% CI: 6.81-11.21], p 1/4 0.936) was found. Nevertheless, patients treated with osimertinib had a superior OS of 17.0 months (95% CI: 15.13-18.94) compared with those not treated with osimertinib who had a mOS of 5.5 months (95% CI: 4.34-6.63), regardless of T790M mutational status (hazard ratio: 0.36 [95% CI: 0.28- 0.47], p < 0.001). This was also considerably longer even than the mOS of 8.7 months (95% CI: 7.01-10.39) of those who were never treated with osimertinib but had firstor second-generation EGFR tyrosine kinase inhibitors.Conclusions: Osimertinib is a promising treatment option for EGFR-mutated NSCLC with LM regardless of T790M mutational status. (C) 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.