表皮生长因子受体突变型肺腺癌脑转移患者中厄洛替尼对比放疗的疗效。
Erlotinib versus radiation therapy for brain metastases in patients with EGFR-mutant lung adenocarcinoma.
机构信息
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
出版信息
Int J Radiat Oncol Biol Phys. 2014 Jun 1;89(2):322-9. doi: 10.1016/j.ijrobp.2014.02.022. Epub 2014 Mar 25.
PURPOSE/OBJECTIVES: Radiation therapy (RT) is the principal modality in the treatment of patients with brain metastases (BM). However, given the activity of EGFR tyrosine kinase inhibitors in the central nervous system, it is uncertain whether upfront brain RT is necessary for patients with EGFR-mutant lung adenocarcinoma with BM.
METHODS AND MATERIALS
Patients with EGFR-mutant lung adenocarcinoma and newly diagnosed BM were identified.
RESULTS
222 patients were identified. Exclusion criteria included prior erlotinib use, presence of a de novo erlotinib resistance mutation, or incomplete data. Of the remaining 110 patients, 63 were treated with erlotinib, 32 with whole brain RT (WBRT), and 15 with stereotactic radiosurgery (SRS). The median overall survival (OS) for the whole cohort was 33 months. There was no significant difference in OS between the WBRT and erlotinib groups (median, 35 vs 26 months; P=.62), whereas patients treated with SRS had a longer OS than did those in the erlotinib group (median, 64 months; P=.004). The median time to intracranial progression was 17 months. There was a longer time to intracranial progression in patients who received WBRT than in those who received erlotinib upfront (median, 24 vs 16 months, P=.04). Patients in the erlotinib or SRS group were more likely to experience intracranial failure as a component of first failure, whereas WBRT patients were more likely to experience failure outside the brain (P=.004).
CONCLUSIONS
The survival of patients with EGFR-mutant adenocarcinoma with BM is notably long, whether they receive upfront erlotinib or brain RT. We observed longer intracranial control with WBRT, even though the WBRT patients had a higher burden of intracranial disease. Despite the equivalent survival between the WBRT and erlotinib group, this study underscores the role of WBRT in producing durable intracranial control in comparison with a targeted biologic agent with known central nervous system activity.
目的
放射治疗（RT）是治疗脑转移瘤（BM）患者的主要方式。然而，鉴于表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）在中枢神经系统中的活性，对于携带 EGFR 突变的肺腺癌伴 BM 的患者， upfront 脑 RT 是否必要尚不确定。
方法与材料
本研究纳入了携带 EGFR 突变的肺腺癌且初诊为 BM 的患者。
结果
共纳入 222 例患者。排除标准包括先前使用厄洛替尼、存在新的厄洛替尼耐药突变或数据不完整。在剩余的 110 例患者中，63 例接受厄洛替尼治疗，32 例接受全脑放疗（WBRT），15 例接受立体定向放射外科治疗（SRS）。全队列的中位总生存期（OS）为 33 个月。WBRT 组和厄洛替尼组的 OS 无显著差异（中位 OS，35 个月 vs 26 个月；P=.62），而 SRS 组患者的 OS 长于厄洛替尼组（中位 OS，64 个月；P=.004）。颅内进展的中位时间为 17 个月。WBRT 组的颅内进展时间长于厄洛替尼组（中位时间，24 个月 vs 16 个月，P=.04）。厄洛替尼组或 SRS 组患者更可能发生颅内失败，而 WBRT 组患者更可能发生脑外失败（P=.004）。
结论
无论患者接受 upfront 厄洛替尼治疗还是脑 RT，携带 EGFR 突变的腺癌伴 BM 的生存时间均明显延长。我们观察到 WBRT 可获得更长的颅内控制时间，尽管 WBRT 患者的颅内疾病负担更高。尽管 WBRT 组和厄洛替尼组的生存时间相当，但本研究强调了 WBRT 在产生持久颅内控制方面与已知具有中枢神经系统活性的靶向生物制剂相比的作用。
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