Department of Chemotherapy, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou 310022, China; Key Laboratory, Diagnosis and Treatment Technology on Thoracic Oncology, Zhejiang Province, Hangzhou, China.
Department of Chemotherapy, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou 310022, China; Key Laboratory, Diagnosis and Treatment Technology on Thoracic Oncology, Zhejiang Province, Hangzhou, China.
J Clin Neurosci. 2014 Apr;21(4):591-5. doi: 10.1016/j.jocn.2013.05.022. Epub 2013 Aug 11.
Survival and treatment options are limited for patients with brain metastases arising from non-small cell lung cancer (NSCLC). We evaluated erlotinib and gefitinib as salvage treatments for NSCLC patients with brain metastases that failed to respond to radiotherapy in a retrospective study. Survival was estimated using Kaplan-Meier analysis and log-rank tests. Multivariable predictors were assessed using the Cox proportional hazards model. Epidermal growth factor receptor (EGFR) mutations were assessed in part using sequencing methods. The 103 NSCLC patients who were treated with gefitinib or erlotinib for salvage treatment for brain metastases between January 2005 and December 2011 had overall objective response rates (ORR) of 11.7%, disease control rates (DCR) of 53.4%, 3.6 months of median progression-free survival (PFS), and 7.5 months of median survival. Intracranial disease had an ORR of 11.7% and a DCR of 70.9%. Extracranial disease had an ORR of 8.7% and a DCR of 66.0%. Nine patients (of 22 tested) were documented with EGFR mutations (five with deletion in exon 19 and four with L858R in exon 21). The median PFS for EGFR mutation patients was 9.0 months, versus 3.1 months for wild-type patients (p=0.001). The recursive partitioning analysis class was the only factor predictive of PFS using univariate analyses and was associated with survival in the multivariate analysis. Our retrospective data suggest a potential role for gefitinib and erlotinib in advanced NSCLC patients with brain metastases which have failed to respond to radiotherapy. Patients with EGFR mutations benefited most from treatment.
对于非小细胞肺癌（NSCLC）脑转移患者，生存和治疗选择有限。我们在一项回顾性研究中评估了厄洛替尼和吉非替尼作为 NSCLC 脑转移患者对放疗无反应的挽救治疗。使用 Kaplan-Meier 分析和对数秩检验估计生存情况。使用 Cox 比例风险模型评估多变量预测因子。部分采用测序方法评估表皮生长因子受体（EGFR）突变。2005 年 1 月至 2011 年 12 月期间，103 例 NSCLC 患者接受吉非替尼或厄洛替尼治疗脑转移的挽救治疗，总体客观缓解率（ORR）为 11.7%，疾病控制率（DCR）为 53.4%，中位无进展生存期（PFS）为 3.6 个月，中位总生存期为 7.5 个月。颅内疾病的 ORR 为 11.7%，DCR 为 70.9%。颅外疾病的 ORR 为 8.7%，DCR 为 66.0%。22 例患者中有 9 例（9 例中有 5 例存在 19 号外显子缺失，4 例存在 21 号外显子 L858R 突变）存在 EGFR 突变。EGFR 突变患者的中位 PFS 为 9.0 个月，而野生型患者为 3.1 个月（p=0.001）。递归分区分析分类是单变量分析中唯一预测 PFS 的因素，并且与多变量分析中的生存相关。我们的回顾性数据表明，厄洛替尼和吉非替尼可能对放疗后进展的 NSCLC 脑转移患者有效。EGFR 突变患者从治疗中获益最大。
