Kashima Jumpei, Okuma Yusuke, Miwa Maki, Hosomi Yukio
Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan.
Division of Oncology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan.
Jpn J Clin Oncol. 2017 Apr 1;47(4):357-362. doi: 10.1093/jjco/hyw206.
Leptomeningeal carcinomatosis is a relatively rare metastatic form of non-small cell lung cancer, which can impact prognosis. There is an increasing need for selecting suitable epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors among those currently included in standard care for EGFR mutation-positive patients. We compared the efficacy of gefitinib and erlotinib in survival of patients with leptomeningeal carcinomatosis.
The medical records of 269 patients who received tyrosine kinase inhibitors at a single center were retrospectively reviewed. Overall, 22 patients (8.2%) were treated with tyrosine kinase inhibitors for leptomeningeal carcinomatosis from non-small cell lung cancer with EGFR mutation between 2006 and 2016. Time to death from leptomeningeal carcinomatosis diagnosis was compared between the gefitinib and erlotinib groups.
Gefitinib and erlotinib were administrated to 5 and 17 patients, respectively. Median progression-free survival was longer in the erlotinib group than in the gefitinib group (6.60 vs 2.12 months, P = 0.07). Overall survival was more than twice as long in the erlotinib arm compared with that in the gefitinib arm (7.20 vs 2.99 months, P = 0.32). Response in patients with exon 19 deletion was better than in those with exon 21 mutation (overall survival, 7.20 and 5.62 months, respectively, P = 0.12).
Erlotinib seemed more effective than gefitinib in prolonging survival in leptomeningeal carcinomatosis from EGFR mutation-positive non-small cell lung cancer and may be particularly beneficial in patients with EGFR exon 19 mutations, warranting further studies.
软脑膜癌病是一种相对罕见的非小细胞肺癌转移形式，会影响预后。在目前用于表皮生长因子受体（EGFR）突变阳性患者标准治疗的药物中，选择合适的EGFR酪氨酸激酶抑制剂的需求日益增加。我们比较了吉非替尼和厄洛替尼对软脑膜癌病患者生存的疗效。
回顾性分析了在单一中心接受酪氨酸激酶抑制剂治疗的269例患者的病历。总体而言，2006年至2016年间，22例（8.2%）患者因EGFR突变的非小细胞肺癌导致的软脑膜癌病接受了酪氨酸激酶抑制剂治疗。比较了吉非替尼组和厄洛替尼组从软脑膜癌病诊断至死亡的时间。
分别有5例和17例患者接受了吉非替尼和厄洛替尼治疗。厄洛替尼组的无进展生存期长于吉非替尼组（6.60个月对2.12个月，P = 0.07）。厄洛替尼组的总生存期是吉非替尼组的两倍多（7.20个月对2.99个月，P = 0.32）。外显子19缺失患者的反应优于外显子21突变患者（总生存期分别为7.20个月和5.62个月，P = 0.12）。
在EGFR突变阳性的非小细胞肺癌所致软脑膜癌病患者中，厄洛替尼在延长生存期方面似乎比吉非替尼更有效，对EGFR外显子19突变患者可能尤其有益，值得进一步研究。
