Medical Oncology Department, University Hospital Arnau de Vilanova, Avda. Rovira Roure, Lleida, Spain,
Clin Transl Oncol. 2013 Nov;15(11):959-64. doi: 10.1007/s12094-013-1035-z. Epub 2013 Apr 20.
Advanced non-small cell lung cancer (NSCLC) is a common and lethal malignancy that has rarely benefited from chemotherapy. Erlotinib is highly effective in NSCLC patients selected by clinical characteristics and/or the presence of epidermal growth factor receptor-sensitizing mutations. However, the way to delay or bypass erlotinib resistance is not systematically addressed. Different erlotinib-failure modes have been reported in NSCLC, and strategies to prolong erlotinib efficacy are perhaps adaptable to them. We report the feasibility and efficacy of continued erlotinib maintenance and local salvage radiation to overcome erlotinib resistances in selected NSCLC patients.
Thirty of 52 consecutive erlotinib-treated advanced NSCLC from the NYU Langone Medical Center and the Arnau de Vilanova Hospital of Lleida responded initially to erlotinib. Twenty-six patients eventually showed a generalized-progression to erlotinib, and four progressed in solitary tumor sites. These four patients were treated with continued erlotinib maintenance and local salvage radiation.
The progression-free survival (PFS) was statistically similar in patients with oligo or generalized-progression to erlotinib. However, all four cases with solitary-progression did benefit from continued erlotinib maintenance and salvage radiation with 41-140 % prolongation of PFS. It was reflected in an improved overall survival when they were compared with patients with generalized-progression (76.4 vs. 19.9 months; p = 0.018).
Continued erlotinib maintenance and local salvage radiation is feasible and could contribute to a better outcome in selected NSCLC patients with solitary-progression to erlotinib. Prospective randomized trials of this strategy are warranted.
晚期非小细胞肺癌（NSCLC）是一种常见且致命的恶性肿瘤，很少从化疗中受益。厄洛替尼对通过临床特征和/或表皮生长因子受体敏感突变选择的 NSCLC 患者具有高度疗效。然而，延迟或绕过厄洛替尼耐药的方法尚未系统解决。在 NSCLC 中已经报道了不同的厄洛替尼耐药模式，并且延长厄洛替尼疗效的策略或许可以适应它们。我们报告了在选定的 NSCLC 患者中继续使用厄洛替尼维持治疗和局部挽救性放疗来克服厄洛替尼耐药的可行性和疗效。
来自纽约大学朗格尼医学中心和莱里达阿瑙德维拉诺瓦医院的 52 例连续接受厄洛替尼治疗的晚期 NSCLC 患者中，有 30 例最初对厄洛替尼有反应。26 例患者最终出现了厄洛替尼的全身性进展，4 例患者出现了孤立肿瘤部位的进展。这 4 例患者接受了继续厄洛替尼维持治疗和局部挽救性放疗。
寡进展或全身性进展至厄洛替尼的患者的无进展生存期（PFS）无统计学差异。然而，所有 4 例孤立性进展的患者都从继续厄洛替尼维持治疗和挽救性放疗中获益，PFS 延长了 41-140%。与全身性进展的患者相比，这反映在总体生存率的改善上（76.4 与 19.9 个月；p = 0.018）。
继续厄洛替尼维持治疗和局部挽救性放疗在选择的孤立性进展至厄洛替尼的 NSCLC 患者中是可行的，并可能有助于获得更好的结果。需要进行前瞻性随机试验来评估这种策略。
