非小细胞肺癌阳性患者的治疗模式与生存情况：一项加拿大回顾性研究。
Treatment patterns and survival in patients with positive non-small-cell lung cancer: a Canadian retrospective study.
作者信息
Kayaniyil S, Hurry M, Wilson J, Wheatley-Price P, Melosky B, Rothenstein J, Cohen V, Koch C, Zhang J, Osenenko K, Liu G
机构信息
icon Health Economics and Epidemiology, Vancouver, BC.
Novartis Pharmaceuticals Canada, Dorval, QC.
出版信息
Curr Oncol. 2016 Dec;23(6):e589-e597. doi: 10.3747/co.23.3273. Epub 2016 Dec 21.
BACKGROUND
Crizotinib was the first agent approved for the treatment of anaplastic lymphoma kinase ()-positive (+) non-small-cell lung cancer (nsclc), followed by ceritinib. However, patients eventually progress or develop resistance to crizotinib. With limited real-world data available, the objective of the present work was to evaluate treatment patterns and survival after crizotinib in patients with locally advanced or metastatic + nsclc in Canada.
METHODS
In this retrospective study at 6 oncology centres across Canada, medical records of patients with locally advanced or metastatic + nsclc were reviewed. Demographic and clinical characteristics, treatments, and outcomes data were abstracted. Analyses focused on patients who discontinued crizotinib treatment.
RESULTS
Of the 97 patients included, 9 were crizotinib-naïve, and 39 were still receiving crizotinib at study end. The 49 patients who discontinued crizotinib treatment were included in the analysis. Of those 49 patients, 43% received ceritinib at any time, 20% subsequently received systemic chemotherapy only (but never ceritinib), and 37% received no further treatment or died before receiving additional treatment. Median overall survival from crizotinib discontinuation was shorter in patients who did not receive ceritinib than in those who received ceritinib (1.7 months vs. 20.4 months, < 0.001). In a multivariable analysis, factors associated with poorer survival included lack of additional therapies (particularly ceritinib), male sex, and younger age, but not smoking status; patients of Asian ethnicity showed a nonsignificant trend toward improved survival.
CONCLUSIONS
A substantial proportion of patients with + nsclc received no further treatment or died before receiving additional treatment after crizotinib. Treatment with systemic agents was associated with improved survival, with ceritinib use being associated with the longest survival.
背景
克唑替尼是首个被批准用于治疗间变性淋巴瘤激酶（ALK）阳性（+）非小细胞肺癌（NSCLC）的药物，随后是色瑞替尼。然而，患者最终会出现疾病进展或对克唑替尼产生耐药。由于可用的真实世界数据有限，本研究的目的是评估加拿大局部晚期或转移性ALK+ NSCLC患者接受克唑替尼治疗后的治疗模式和生存情况。
方法
在加拿大6个肿瘤中心进行的这项回顾性研究中，对局部晚期或转移性ALK+ NSCLC患者的病历进行了审查。提取了人口统计学和临床特征、治疗方法及结局数据。分析集中于停止克唑替尼治疗的患者。
结果
纳入的97例患者中，9例未接受过克唑替尼治疗，39例在研究结束时仍在接受克唑替尼治疗。49例停止克唑替尼治疗的患者被纳入分析。在这49例患者中，43%的患者在任何时候接受过色瑞替尼治疗，20%的患者随后仅接受了全身化疗（但从未接受过色瑞替尼治疗），37%的患者未接受进一步治疗或在接受额外治疗前死亡。未接受色瑞替尼治疗的患者从停止克唑替尼治疗后的中位总生存期短于接受色瑞替尼治疗的患者（1.7个月对20.4个月，P<0.001）。在多变量分析中，与较差生存相关的因素包括未接受额外治疗（尤其是色瑞替尼）、男性和较年轻的年龄，但不包括吸烟状态；亚洲种族患者的生存改善趋势不显著。
结论
相当一部分ALK+ NSCLC患者在克唑替尼治疗后未接受进一步治疗或在接受额外治疗前死亡。全身治疗药物与生存改善相关，使用色瑞替尼与最长生存期相关。
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