Department of Respiratory Medicine, Shandong Provincial Hospital, Shandong University, Jinan 250021, PR China.
Oncol Rep. 2012 Mar;27(3):880-90. doi: 10.3892/or.2011.1559. Epub 2011 Nov 23.
The aim of the present study was to evaluate the therapeutic effects and adverse reactions of Tarceva treatment for malignant pleural effusion (MPE) caused by metastatic lung adenocarcinomas. One hundred and twenty-eight patients who failed first-line chemotherapy drug treatment were divided into a mutation and a non-mutation group according to the presence or absence of epidermal growth factor receptor (EGFR) mutations. Each patient received closed drainage combined with simple negative pressure suction after thoracoscopic talc poudrage pleurodesis and oral Tarceva treatment. Short-term and long-term clinical therapeutic effects of Tarceva were evaluated. The EGFR mutation rate in pleural metastatic tissues of lung adenocarcinoma acquired through video-assisted thoracoscopic surgery was higher compared to that in surgical resection specimens, plasma specimens and pleural effusion specimens compared to previously reported results. There were significant statistical differences in the average extubation time (p<0.01), drainage volume of pleural effusion (p<0.05), Karnofsky score and formation of encapsulated pleural effusion 4 weeks after surgery (p<0.05) between these two groups. The number of patients with mild pleural hypertrophy in the mutation group was significantly higher compared to the non-mutation group (p<0.01), while the number of patients with severe pleural hypertrophy was significantly reduced (p<0.05). There was significant statistical discrepancy between these two groups in terms of improvement of peripheral blood carcinoembryonic antigen and tissue polypeptide antigen after 4 weeks of therapy. The complete remission rate and the efficacy rate were higher in the mutation group compared to that in the non-mutation group (p<0.05). There was a longer overall survival time after Tarceva treatment in patients with EGFR mutations than those without EGFR mutation. EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy. Detection of EGFR mutations may determine the responsiveness of malignant pleural effusion to Tarceva treatment.
本研究旨在评估特罗凯治疗表皮生长因子受体（EGFR）基因突变型转移性肺腺癌所致恶性胸腔积液（MPE）的疗效和不良反应。128 例一线化疗药物治疗失败的患者，根据有无 EGFR 突变分为突变组和非突变组，两组患者均经胸腔镜滑石粉胸膜固定术后行胸腔闭式引流联合单纯负压吸引，并口服特罗凯治疗。评估特罗凯短期和长期临床疗效。与之前的报道相比，通过电视辅助胸腔镜手术获得的肺腺癌胸膜转移组织 EGFR 突变率高于外科切除标本、血浆标本和胸腔积液标本。两组患者的平均拔管时间（p<0.01）、胸腔引流液量（p<0.05）、Karnofsky 评分及术后 4 周包裹性胸腔积液形成比较，差异均有统计学意义（p<0.05）。突变组轻度胸膜肥厚患者例数明显多于非突变组（p<0.01），而重度胸膜肥厚患者例数明显减少（p<0.05）。两组患者治疗 4 周后外周血癌胚抗原和组织多肽抗原改善情况比较，差异有统计学意义（p<0.05）。突变组完全缓解率和总有效率均明显高于非突变组（p<0.05）。EGFR 突变患者特罗凯治疗后的总生存时间长于 EGFR 无突变患者。EGFR 突变预测 EGFR-TKI 特罗凯治疗肺腺癌恶性胸腔积液的疗效良好。EGFR 突变检测可能决定恶性胸腔积液对特罗凯治疗的反应性。
