Wu Wen-Shuo, Wu Chieh-Hung, Lai Shinn-Liang, Chiu Chao-Hua, Shih Jen-Fu, Lee Yu-Chin, Chen Yuh-Min
Department of Chest Medicine, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.
Am J Clin Oncol. 2016 Dec;39(6):556-562. doi: 10.1097/COC.0000000000000096.
Erlotinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) with promising efficacy in treating pulmonary adenocarcinoma. Treatment choices are few when patients with pulmonary adenocarcinoma have failed both EGFR-TKI and chemotherapy. The purpose of this study was to demonstrate the efficacy of erlotinib as salvage treatment for these nonresponsive patients.
We retrospectively reviewed the chart records of our stage IV pulmonary adenocarcinoma patients who were diagnosed and treated between July 2004 and June 2013. Clinical data, including type of response to treatment, time to disease progression, duration between the end of first-line EGFR-TKI treatment and starting erlotinib treatment, and overall survival time, were collected.
A total of 98 patients were enrolled, and all had been treated with EGFR-TKI, either as a first-line therapy or following platinum-based chemotherapy; of them, 60 patients had a response to initial EGFR-TKI treatment. All received erlotinib as salvage treatment after their disease had progressed following EGFR-TKI treatment. Ninety-three (93.3%) patients had also received previous platinum-based chemotherapy. The median progression-free survival with erlotinib as salvage treatment for patients with and without a response to front-line EGFR-TKI was 4.9 and 3.4 months (P=0.869), respectively. The progression-free survival with erlotinib treatment in the sensitizing EGFR mutation group was 4.3 months, and in the EGFR wild-type group it was 2.6 months (P=0.22).
In pulmonary adenocarcinoma patients who had been heavily treated, erlotinib could still be a choice, regardless of the EGFR mutation status, or whether the patients had responded to previous EGFR-TKI treatment.
厄洛替尼是一种表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI），在治疗肺腺癌方面具有显著疗效。当肺腺癌患者的表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）和化疗均失败时，治疗选择极为有限。本研究旨在证实厄洛替尼作为挽救治疗对这些无反应患者的疗效。
我们回顾性分析了2004年7月至2013年6月期间确诊并接受治疗的IV期肺腺癌患者的病历记录。收集了临床数据，包括治疗反应类型、疾病进展时间、一线EGFR-TKI治疗结束至开始厄洛替尼治疗的间隔时间以及总生存时间。
共纳入98例患者，所有患者均接受过EGFR-TKI治疗，作为一线治疗或铂类化疗后治疗；其中，60例患者对初始EGFR-TKI治疗有反应。所有患者在EGFR-TKI治疗后疾病进展，均接受厄洛替尼作为挽救治疗。93例（93.3%）患者还接受过铂类化疗。一线EGFR-TKI治疗有反应和无反应的患者接受厄洛替尼作为挽救治疗的中位无进展生存期分别为4.9个月和3.4个月（P=0.869）。EGFR敏感突变组厄洛替尼治疗的无进展生存期为4.3个月，EGFR野生型组为2.6个月（P=0.22）。
在接受过大量治疗的肺腺癌患者中，无论EGFR突变状态如何，或患者先前是否对EGFR-TKI治疗有反应，厄洛替尼仍可作为一种选择。
