Ying Geng Zhen, Chang Jiao Shun, Cui Liu Shi, Li Ying, Feng Liu Zhe, Qing Zhang Guo, Jie Wang Li, Qu Feng
Department of Medical Oncology, PLA General Hospital, Haidian District, Beijing, China.
J BUON. 2013 Oct-Dec;18(4):899-907.
With the improvements in first- and second-line treatments in non-small cell lung cancer (NSCLC), there is an increasing number of patients who receive third-line therapy. No other standard choice for third-line therapy aside from erlotinib is possible. This study investigated the efficacy and safety of single-agent chemotherapy, epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), doublet chemotherapy and chemo-targeted therapy as third-line treatment in advanced NSCLC.
This study included 233 stage IIIb or IV NSCLC patients who were retrospectively reviewed to explore the differences in survival between different treatments.
The median progression free survival (PFS) in the EGFR-TKIs, single-agent, doublet and chemo-targeted groups was 3.83, 2.72, 2.86 and 3.29 months, respectively (p = 0.073). The median OS from the initiation of the third-line treatment was 11.16, 8.24, 8.49 and 9.33 months in the 4 groups (p=0.02). The rates of grade IIIIV toxicities were 16.4, 27.6, 57.3 and 44.0% ( p <0.001), respectively with the third-line treatment, and overall survival (OS) was prolonged in patients who never smoked (p=0.040), had adenocarcinoma (p=0.034), had good ECOG performance status (PS) (p=0.012) and achieved disease control after both first-and second-line treatments (p =0.031).
Patients with advanced NSCLC who never smoked, had adenocarcinoma, have good PS, and good disease control from the first- and second-line therapies could benefit more with third-line treatment. EGFR-TKIs and chemo-targeted therapy showed increased OS compared with single-agent and doublet chemotherapy.
随着非小细胞肺癌（NSCLC）一线和二线治疗的改善，接受三线治疗的患者数量日益增加。除厄洛替尼外，没有其他三线治疗的标准选择。本研究调查了单药化疗、表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）、双联化疗和化疗靶向治疗作为晚期NSCLC三线治疗的疗效和安全性。
本研究纳入了233例Ⅲb期或Ⅳ期NSCLC患者，对其进行回顾性分析以探讨不同治疗方法之间的生存差异。
EGFR-TKIs组、单药组、双联组和化疗靶向组的中位无进展生存期（PFS）分别为3.83、2.72、2.86和3.29个月（p = 0.073）。四线治疗开始后的中位总生存期（OS）在4组中分别为11.16、8.24、8.49和9.33个月（p = 0.02）。三线治疗的Ⅲ/Ⅳ级毒性发生率分别为16.4%、27.6%、57.3%和44.0%（p < 0.001），从不吸烟的患者（p = 0.040）、患有腺癌的患者（p = 0.034）、ECOG体能状态（PS）良好的患者（p = 0.012）以及在一线和二线治疗后实现疾病控制的患者（p = 0.031）的总生存期（OS）延长。
从不吸烟、患有腺癌、PS良好且一线和二线治疗疾病控制良好的晚期NSCLC患者接受三线治疗可能获益更多。与单药化疗和双联化疗相比，EGFR-TKIs和化疗靶向治疗显示OS增加。
