对一线酪氨酸激酶抑制剂和二线化疗的总体反应可预测表皮生长因子受体突变腺癌的生存结果。

Overall response to first-line tyrosine kinase inhibitor and second-line chemotherapy is predictive of survival outcome in epidermal growth factor receptor-mutated adenocarcinoma.

作者信息

Kuo Scott Chih-Hsi, Hsu Ping-Chih, Chen Chih-Hung, Yu Chih-Teng, Wang Chih-Liang, Chung Fu-Tsai, Lin Shu-Min, Lo Yu-Lun, Chen Tse-Ching, Liu Chien-Ying, Yang Cheng-Ta

出版信息

Chemotherapy. 2014;60(3):201-10. doi: 10.1159/000371735.

DOI:10.1159/000371735

PMID:25871639

Abstract

BACKGROUND

First-line epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are effective for the treatment of lung adenocarcinoma with an EGFR-sensitizing mutation, but resistance is inevitable. Chemotherapy is widely used in the second-line setting. The outcome following this treatment scheme has not been thoroughly evaluated.

METHODS

From 2007 to 2011, consecutive patients with mutated EGFR receiving first-line TKI and second-line chemotherapy were retrospectively reviewed. The overall response was categorized into double responder, single responder and double nonresponder.

RESULTS

Following this treatment scheme, baseline Eastern Cooperative Oncology Group (ECOG) performance status 0-1 (HR 0.60; 95% CI 0.37-0.98; p = 0.041) and double responder (HR 0.24; 95% CI 0.07-0.78; p = 0.018) were independent predictors of overall survival. Absence of pleural metastasis independently predicted the response to first-line TKI (OR 2.60; 95% CI 1.13-5.99; p = 0.025). In TKI responders, ECOG performance status 0-1 before chemotherapy (OR 4.95; 95% CI 1.15-21.28; p = 0.006), an exon 19 deletion (OR 4.74; 95% CI 1.30-17.21; p = 0.018) and progression-free survival (PFS) on first-line TKI (OR 1.02; 95% CI 1.01-1.09; p = 0.049) independently predicted the response to second-line chemotherapy. A moderate linear relationship (Pearson's r = 0.441; p = 0.001) existed between the PFS of this treatment scheme in TKI responders.

CONCLUSION

The status of double responder to first-line TKI and second-line chemotherapy was predictive of improved survival in EGFR-mutated adenocarcinoma.

摘要

背景

一线表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKIs）对治疗具有EGFR敏感突变的肺腺癌有效，但耐药不可避免。化疗广泛用于二线治疗。该治疗方案后的结果尚未得到充分评估。

方法

回顾性分析2007年至2011年连续接受一线TKI和二线化疗的EGFR突变患者。总体反应分为双反应者、单反应者和双无反应者。

结果

按照该治疗方案，基线东部肿瘤协作组（ECOG）体能状态0-1（风险比[HR]0.60；95%置信区间[CI]0.37-0.98；p=0.041）和双反应者（HR0.24；95%CI0.07-0.78；p=0.018）是总生存期的独立预测因素。无胸膜转移独立预测对一线TKI的反应（优势比[OR]2.60；95%CI1.13-5.99；p=0.025）。在TKI反应者中，化疗前ECOG体能状态0-1（OR4.95；95%CI1.15-21.28；p=0.006）、19外显子缺失（OR4.74；95%CI1.30-17.21；p=0.018）和一线TKI的无进展生存期（PFS）（OR1.02；95%CI1.01-1.09；p=0.049）独立预测对二线化疗的反应。TKI反应者中该治疗方案的PFS之间存在中度线性关系（Pearson相关系数r=0.441；p=0.001）。