Masuda T, Imai H, Kuwako T, Miura Y, Yoshino R, Kaira K, Shimizu K, Sunaga N, Tomizawa Y, Ishihara S, Mogi A, Hisada T, Minato K, Takise A, Saito R, Yamada M
Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Clin Transl Oncol. 2015 Sep;17(9):702-9. doi: 10.1007/s12094-015-1297-8. Epub 2015 May 20.
Gefitinib is an effective first-line chemotherapy for advanced non-small cell lung cancer (NSCLC) patients harboring sensitive EGFR mutations. However, whether second-line platinum combination chemotherapy after first-line gefitinib treatment shows similar effects to first-line platinum combination chemotherapy in these patients remains unclear. Therefore, we here aimed to investigate the efficacy of platinum combination chemotherapy after first-line gefitinib treatment in NSCLC patients harboring sensitive EGFR mutations.
METHODS/PATIENTS: We retrospectively evaluated the clinical effects of second-line platinum combination chemotherapy after first-line gefitinib treatment in NSCLC patients harboring sensitive EGFR mutations (exon 19 deletion or exon 21 L858R mutation) at five institutions. All patients were initially treated with gefitinib (250 mg/day) followed by platinum combination chemotherapy as second-line chemotherapy.
Between January 2006 and December 2012, 42 patients [8 men, 34 women; median age, 63 years (range 39-75 years)] were enrolled. The overall response rate, disease control rate, and median progression-free survival (PFS) were 26.2, 61.9%, and 5.1 months, respectively, after the second-line treatment. The corresponding values for first-line gefitinib treatment were 69.0, 95.2%, and 11.1 months, respectively. Moreover, second-line platinum combination chemotherapy with pemetrexed or bevacizumab-containing regimens was independently associated with improved PFS.
Second-line platinum combination chemotherapy after first-line gefitinib treatment in NSCLC patients harboring sensitive EGFR mutations was effective and showed equivalent outcomes to first-line platinum combination chemotherapy. After failure of first-line gefitinib therapy, second-line platinum combination chemotherapy with pemetrexed or bevacizumab might result in improved PFS.
吉非替尼是对携带敏感表皮生长因子受体（EGFR）突变的晚期非小细胞肺癌（NSCLC）患者有效的一线化疗药物。然而，一线吉非替尼治疗后二线铂类联合化疗在这些患者中是否显示出与一线铂类联合化疗相似的效果仍不清楚。因此，我们在此旨在研究一线吉非替尼治疗后铂类联合化疗对携带敏感EGFR突变的NSCLC患者的疗效。
方法/患者：我们回顾性评估了五家机构中一线吉非替尼治疗后二线铂类联合化疗对携带敏感EGFR突变（外显子19缺失或外显子21 L858R突变）的NSCLC患者的临床效果。所有患者最初均接受吉非替尼治疗（250毫克/天），随后接受铂类联合化疗作为二线化疗。
在2006年1月至2012年12月期间，共纳入42例患者[8例男性，34例女性；中位年龄63岁（范围39 - 75岁）]。二线治疗后的总缓解率、疾病控制率和中位无进展生存期（PFS）分别为26.2%、61.9%和5.1个月。一线吉非替尼治疗的相应数值分别为69.0%、95.2%和11.1个月。此外，含培美曲塞或贝伐单抗方案的二线铂类联合化疗与PFS改善独立相关。
一线吉非替尼治疗后二线铂类联合化疗对携带敏感EGFR突变的NSCLC患者有效，且显示出与一线铂类联合化疗相当的结果。一线吉非替尼治疗失败后，含培美曲塞或贝伐单抗的二线铂类联合化疗可能会改善PFS。
