Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China.
Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Sci Rep. 2017 Feb 17;7:42979. doi: 10.1038/srep42979.
Whether bisphosphonates could enhance the effect of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in non-small-cell lung cancer (NSCLC) patients with EGFR mutation and bone metastases (BM) remains unknown. EGFR mutation status were collected from 1560 patients with NSCLC and BM. 356 NSCLC patients with EGFR mutation and BM were identified. Among them, 91 patients received EGFR-TKIs alone and 105 patients received EGFR-TKIs plus bisphosphonates as first-line therapy. Comparing to TKIs alone, EGFR-TKIs plus bisphosphonates had a statistically significant longer progression-free survival (PFS: 11.6 vs. 9.3 months; HR = 0.68, P = 0.009), while a similar overall survival (OS: 20.5 vs. 19.5 months; HR = 0.95, P = 0.743) in patients with EGFR-mutant NSCLC and BM. The incidence of skeletal-related events in combined group was numerically lower than that in EGFR-TKIs alone group (29.7% vs. 39.4%, P = 0.147). In multivariate analysis, EGFR mutation was found to be a significant independent prognostic factor for OS in NSCLC patients with BM (HR = 0.710, P = 0.021). In conclusion, EGFR mutation was the significant independent prognostic factor for OS and the addition of bisphosphonates to EGFR-TKIs could enhance the antitumor effect of EGFR-TKIs in patients with EGFR-mutant NSCLC and BM.
表皮生长因子受体 (EGFR)-酪氨酸激酶抑制剂 (TKI) 是否能增强 EGFR 突变和骨转移 (BM) 的非小细胞肺癌 (NSCLC) 患者的疗效尚不清楚。从 1560 例 NSCLC 和 BM 患者中收集 EGFR 突变状态。确定了 356 例 EGFR 突变和 BM 的 NSCLC 患者。其中，91 例患者单独接受 EGFR-TKI 治疗，105 例患者接受 EGFR-TKI 联合双膦酸盐作为一线治疗。与单独使用 TKI 相比，EGFR-TKI 联合双膦酸盐具有统计学意义的更长的无进展生存期（PFS：11.6 与 9.3 个月；HR=0.68，P=0.009），而在 EGFR 突变型 NSCLC 和 BM 患者中总生存期（OS：20.5 与 19.5 个月；HR=0.95，P=0.743）相似。联合组的骨骼相关事件发生率低于单独使用 EGFR-TKI 组（29.7%比 39.4%，P=0.147）。多因素分析显示，EGFR 突变是 BM 中 NSCLC 患者 OS 的独立预后因素（HR=0.710，P=0.021）。总之，EGFR 突变是 OS 的独立预后因素，EGFR-TKI 联合双膦酸盐可以增强 EGFR 突变 NSCLC 和 BM 患者的抗肿瘤作用。
