Center for Clinical Trial, National Cancer Center, Goyang, Gyeonggi 410-769, Republic of Korea.
J Thorac Oncol. 2010 Mar;5(3):361-8. doi: 10.1097/JTO.0b013e3181cee1ea.
Best supportive care only is recommended for patients with advanced non-small cell lung cancer (NSCLC) with poor performance status (PS) of Eastern Cooperative Oncology Group 3 or 4. Recently, the possibility of using epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor therapy has been reported for poor PS patients harboring EGFR mutations.
We retrospectively analyzed 74 patients with advanced NSCLC who were treated with first-line gefitinib during hospitalization for Eastern Cooperative Oncology Group PS 3 or 4. All patients were classified according to three clinical parameters: smoking history, gender, and histology type.
The median age was 64 years (range, 35-86 years). The proportions of females, never smokers, and adenocarcinoma were 51.4%, 54.1%, and 78.4%, respectively. An overall response rate, median progression-free survival (PFS), and median overall survival (OS) was 27.0%, 32 days (95% confidence interval [CI], 22-48 days), and 61 days (95% CI, 7-115 days), respectively. Female gender, never smoking, and adenocarcinoma histology were strong predictors of tumor response. Never smoking and adenocarcinoma were independent predictors of better PFS but not of OS. Seven patients experienced treatment-related adverse effects of grade 3 to 4, which included anorexia (n = 2), pneumonitis (n = 4), and elevated liver enzymes (n = 1). Never-smoker females with adenocarcinoma exhibited a response rate of 50.0%, median PFS of 130 days (95% CI, 51-209 days), and median OS of 236 days (95% CI, 150-322 days).
Gefitinib may provide clinical benefits for patients with NSCLC with poor PS who were selected according to clinically favorable parameters.
对于体能状态（PS）为东部肿瘤协作组（ECOG）3 或 4 的晚期非小细胞肺癌（NSCLC）患者，仅推荐最佳支持治疗。最近，有报道称对于携带 EGFR 突变的 PS 较差的患者，可以使用表皮生长因子受体（EGFR）酪氨酸激酶抑制剂治疗。
我们回顾性分析了 74 例在住院期间接受一线吉非替尼治疗的 ECOG PS 为 3 或 4 的晚期 NSCLC 患者。所有患者均根据三个临床参数进行分类：吸烟史、性别和组织学类型。
中位年龄为 64 岁（范围，35-86 岁）。女性、从不吸烟者和腺癌的比例分别为 51.4%、54.1%和 78.4%。总缓解率、中位无进展生存期（PFS）和中位总生存期（OS）分别为 27.0%、32 天（95%置信区间[CI]，22-48 天）和 61 天（95%CI，7-115 天）。女性、从不吸烟和腺癌组织学是肿瘤反应的强预测因素。从不吸烟和腺癌是 PFS 更好的独立预测因素，但不是 OS 的独立预测因素。7 例患者发生 3-4 级治疗相关不良事件，包括厌食（n=2）、肺炎（n=4）和肝酶升高（n=1）。从不吸烟的女性腺癌患者的缓解率为 50.0%，中位 PFS 为 130 天（95%CI，51-209 天），中位 OS 为 236 天（95%CI，150-322 天）。
对于根据临床有利参数选择的 PS 较差的 NSCLC 患者，吉非替尼可能会带来临床获益。
