晚期肺腺癌表皮生长因子受体酪氨酸激酶抑制剂治疗失败后的处理。
Subsequent treatment of epidermal growth factor receptor-tyrosine kinase inhibitor failure in patients with advanced lung adenocarcinoma.
机构信息
Department of Cellular and Molecular Biology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing, China ; Health Care Ward, The First Affiliated Hospital of Inner Mongolia Medical University Hohhot, China.
Department of Pharmacology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute Beijing, China.
出版信息
Thorac Cancer. 2015 Nov;6(6):678-86. doi: 10.1111/1759-7714.12236. Epub 2015 Feb 12.
BACKGROUND
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) effectively treat advanced non-small cell lung cancer with EGFR-mutation. However, most patients develop acquired resistance without effective therapy subsequent to EGFR-TKI failure. We evaluated the efficacy of subsequent treatment strategies for EGFR-TKI resistance.
METHODS
We retrospectively analyzed 240 patients with advanced lung adenocarcinoma with EGFR-TKI failure and following subsequent treatment. According to the first subsequent strategies after EGFR-TKI failure, patients were divided into groups of EGFR-TKI continuation (21 cases), EGFR-TKI continuation with chemotherapy (23 cases), chemotherapy alone (143 cases), and best supportive care (BSC) (53 cases).
RESULTS
Except for 53 cases of BSC, the disease control rates (DCR) of the remaining 187 patients in the EGFR-TKI continuation, EGFR-TKI continuation with chemotherapy, and chemotherapy alone groups were 66.7%, 73.9%, and 44.8%, respectively. The median post-progression progression-free survival (PFS) for the three groups was 3.0, 3.3, and 2.0 months, respectively. The DCR for the EGFR-TKI continuation with chemotherapy group was significantly higher than the chemotherapy alone group (P = 0.006). The post-progression PFS of the EGFR-TKI continuation with chemotherapy group was significantly longer than the chemotherapy alone group (P = 0.037). The median overall survival in the EGFR-TKI continuation, EGFR-TKI continuation with chemotherapy, chemotherapy alone, and BSC groups were 6.9, 11.6, 8.8, and 0.9 months, respectively. Compared to the BSC group, all groups achieved a survival benefit (P < 0.001).
CONCLUSIONS
EGFR-TKI continuation with chemotherapy could provide benefits for patients with acquired resistance to EGFR-TKI.
背景
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）可有效治疗具有 EGFR 突变的晚期非小细胞肺癌。然而，大多数患者在 EGFR-TKI 失败后会出现无有效治疗的获得性耐药。我们评估了 EGFR-TKI 耐药后后续治疗策略的疗效。
方法
我们回顾性分析了 240 例 EGFR-TKI 失败后接受后续治疗的晚期肺腺癌患者。根据 EGFR-TKI 失败后的首次后续策略，患者分为 EGFR-TKI 继续治疗组（21 例）、EGFR-TKI 继续治疗联合化疗组（23 例）、单独化疗组（143 例）和最佳支持治疗（BSC）组（53 例）。
结果
除了 53 例 BSC 患者外，EGFR-TKI 继续治疗、EGFR-TKI 继续治疗联合化疗和单独化疗组的其余 187 例患者的疾病控制率（DCR）分别为 66.7%、73.9%和 44.8%。三组患者的中位后进展无进展生存期（PFS）分别为 3.0、3.3 和 2.0 个月。EGFR-TKI 继续治疗联合化疗组的 DCR 明显高于单独化疗组（P=0.006）。EGFR-TKI 继续治疗联合化疗组的后进展 PFS 明显长于单独化疗组（P=0.037）。EGFR-TKI 继续治疗、EGFR-TKI 继续治疗联合化疗、单独化疗和 BSC 组的中位总生存期分别为 6.9、11.6、8.8 和 0.9 个月。与 BSC 组相比，所有组均获得生存获益（P<0.001）。
结论
EGFR-TKI 继续治疗联合化疗可为 EGFR-TKI 获得性耐药患者带来获益。
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