Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
J Pain Symptom Manage. 2013 Jul;46(1):1-8. doi: 10.1016/j.jpainsymman.2012.07.007. Epub 2012 Dec 1.
The use of targeted therapy at the end of life has not been well characterized.
To determine the frequency and predictors of targeted therapy use in the last days of life.
All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had contact with our institution within the last three months of life were included. We collected baseline demographics and data on chemotherapy and targeted agents.
Eight hundred sixteen patients were included: average age 62 years (range 21-97), female 48% and white 61%. The median interval between the last treatment and death was 47 (interquartile range [IQR] 21-97) days for targeted agents and 57 (IQR 26-118) days for chemotherapeutic agents. Within the last 30 days of life, 116 (14%) patients received targeted agents and 147 (18%) received chemotherapy. Regimens given in the last 30 days of life included a median of one (IQR 1-2) chemotherapeutic or targeted agent and 43 (5%) patients receiving targeted agents had concurrent chemotherapy. The most common targeted agents in the last 30 days of life were erlotinib (n = 25), bevacizumab (n = 20), rituximab (n = 11), gemtuzumab (n = 8), and temsirolimus (n = 8). On multivariate analysis, younger age (odds ratio [OR] 0.98 per year, P = 0.01), hematologic malignancy (OR = 6.1, P < 0.001), and lung malignancy (OR = 2.6, P = 0.05) were associated with increased targeted agent use in the last 30 days of life.
Targeted agents were used as often as chemotherapy at the end of life, particularly among younger patients and those with hematologic malignancies. Guidelines on targeted therapy use at the end of life are needed.
在生命末期使用靶向治疗尚未得到很好的描述。
确定生命末期使用靶向治疗的频率和预测因素。
纳入 2009 年 9 月 1 日至 2010 年 2 月 28 日期间在休斯顿地区居住且死亡的晚期癌症患者，以及生命最后三个月内在我院就诊的患者。我们收集了基线人口统计学数据以及化疗和靶向药物的数据。
共纳入 816 例患者：平均年龄 62 岁（范围 21-97 岁），女性占 48%，白人占 61%。靶向药物治疗与死亡之间的中位间隔时间为 47（四分位距 [IQR] 21-97）天，化疗药物为 57（IQR 26-118）天。在生命的最后 30 天内，有 116（14%）例患者接受了靶向药物治疗，147（18%）例患者接受了化疗。在生命的最后 30 天内给予的方案中位数为 1 种（IQR 1-2）化疗或靶向药物，43（5%）例接受靶向药物治疗的患者同时接受化疗。生命的最后 30 天内最常用的靶向药物为厄洛替尼（n=25）、贝伐单抗（n=20）、利妥昔单抗（n=11）、吉妥珠单抗（n=8）和替西罗莫司（n=8）。多变量分析显示，年龄较小（每增加 1 岁，比值比 [OR] 0.98，P=0.01）、血液恶性肿瘤（OR=6.1，P<0.001）和肺部恶性肿瘤（OR=2.6，P=0.05）与生命的最后 30 天内使用靶向药物治疗的几率增加有关。
靶向药物与化疗一样常用于生命末期，特别是在年轻患者和血液恶性肿瘤患者中。需要制定生命末期靶向治疗使用指南。
