Zhang Ru-Xia, Cai Dong-Yan, Hong Ting-Ting, Wu Xiao-Hong, Hua Dong
The Forth Affiliated Hospital of Soochow University, Suzhou 214062, China.
Zhonghua Zhong Liu Za Zhi. 2012 Feb;34(2):147-51. doi: 10.3760/cma.j.issn.0253-3766.2012.02.015.
To compare the efficacy of second-line EGFR-TKIs followed by third-line pemetrexed with second-line pemetrexed followed by third-line EGFR-TKIs in patients with advanced lung adenocarcinoma.
From March 2007 to August 2008, 83 patients with advanced lung adenocarcinoma who failed standard first-line chemotherapy were included in this study. The patients who received EGFR-TKIs as second-line therapy followed by third-line pemetrexed were designated as group A (n = 45). The patients who received pemetrexed as second-line therapy followed by third-line EGFR-TKIs were designated as group B (n = 38). PFS and MST were estimated with Kaplan-Meier analysis and the difference between groups were compared with Log-rank test.
The progression-free survival (PFS) after second-line therapy in the groups A and B was 8.05 months (95% CI, 5.90 to 10.20) and 4.20 months (95% CI, 3.33 to 5.06), respectively (P = 0.001). The PFS after second-line therapy in smokers and non-smokers was 3.69 months (95% CI, 5.00 to 7.59) and 7.12 months (95% CI, 5.51 to 8.38), respectively (P = 0.007). The PFS of male and female patients was 5.56 months (95% CI, 4.02 to 7.10) and 6.85 months (95% CI, 4.98 to 7.58), respectively (P = 0.279). The PFS after third-line therapy in groups A and B was 6.88 months (95% CI, 5.07 to 8.69) and 7.60 months (95% CI, 5.59 to 9.12) respectively, (P = 0.899). The PFS after third-line therapy in smokers and non-smokers was 4.95 months (95% CI, 2.83 to 7.05) and 8.49 months (95% CI, 6.27 to 10.76), respectively (P = 0.050). The PFS after third-line therapy in male and female patients was 5. 96 months (95% CI, 4.02 to 7.91) amd 8.38 months (95% CI, 5.68 to 11.07), respectively (P = 0.176). The MST in groups A and B was 23.60 months (95% CI, 19.23 to 28.00) and 15.58 months (95% CI, 11.85 to 19.32), respectively (P = 0.021). The MST in smokers and non-smokers was 11.99 months (95% CI, 8.55 to 15.49) and 23.18 months (95% CI, 19.33 to 27.02), respectively (P = 0.001). The MST in male and female patients was 17.40 months (95% CI, 13. 19 to 21.61) and 22.74 months (95% CI, 18.29 to 27.19), respectively (P = 0.111).
Second line EGFR TKIs followed by third line pemetrexed regimen improves the PFS and MST compared with the regimen second line pemetrexed followed by third line EGFR TKIs in patients with advanced lung adenocarcinoma. Smoking status is an independent prognostic factor. Survival is not influenced by gender. Prospective clinical trials are needed to confirm these findings.
比较晚期肺腺癌患者二线使用表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）后三线使用培美曲塞与二线使用培美曲塞后三线使用EGFR-TKIs的疗效。
2007年3月至2008年8月，83例一线标准化疗失败的晚期肺腺癌患者纳入本研究。接受EGFR-TKIs作为二线治疗后三线使用培美曲塞的患者被指定为A组（n = 45）。接受培美曲塞作为二线治疗后三线使用EGFR-TKIs的患者被指定为B组（n = 38）。采用Kaplan-Meier分析估计无进展生存期（PFS）和总生存期（MST），并采用对数秩检验比较组间差异。
A组和B组二线治疗后的无进展生存期分别为8.05个月（95%可信区间，5.90至10.20）和4.20个月（95%可信区间，3.33至5.06）（P = 0.001）。吸烟者和非吸烟者二线治疗后的PFS分别为3.69个月（95%可信区间，5.00至7.59）和7.12个月（95%可信区间，5.51至8.38）（P = 0.007）。男性和女性患者的PFS分别为5.56个月（95%可信区间，4.02至7.10）和6.85个月（95%可信区间，4.98至7.58）（P = 0.279）。A组和B组三线治疗后的PFS分别为6.88个月（95%可信区间，5.07至8.69）和7.60个月（95%可信区间，5.59至9.12），（P = 0.899）。吸烟者和非吸烟者三线治疗后的PFS分别为4.95个月（95%可信区间，2.83至7.05）和8.49个月（95%可信区间，6.27至10.76）（P = 0.050）。男性和女性患者三线治疗后的PFS分别为5.96个月（95%可信区间，4.02至7.91）和8.38个月（95%可信区间，5.68至11.07）（P = 0.176）。A组和B组的MST分别为23.60个月（95%可信区间，19.23至28.00）和15.58个月（95%可信区间，11.85至19.32）（P = 0.02）。吸烟者和非吸烟者的MST分别为11.99个月（95%可信区间，8.55至15.49）和23.18个月（95%可信区间，19.33至27.02）（P = 0.001）。男性和女性患者的MST分别为17.40个月（95%可信区间，13.19至21.61）和22.74个月（95%可信区间，18.29至27.19）（P = 0.111）。
与晚期肺腺癌患者二线使用培美曲塞后三线使用EGFR-TKIs的方案相比，二线使用EGFR-TKIs后三线使用培美曲塞的方案可改善PFS和MST。吸烟状态是一个独立的预后因素。生存不受性别影响。需要进行前瞻性临床试验来证实这些发现。
