携带EGFR突变的晚期非小细胞肺癌患者接受吉非替尼和厄洛替尼两种EGFR-TKI一线治疗后的中枢神经系统进展：一项对比研究
Central nervous system progression in advanced non-small cell lung cancer patients with EGFR mutations in response to first-line treatment with two EGFR-TKIs, gefitinib and erlotinib: a comparative study.
作者信息
Li Meng-Xia, He Hao, Ruan Zhi-Hua, Zhu Yu-Xi, Li Rong-Qing, He Xiao, Lan Bao-Hua, Zhang Zhi-Min, Liu Guo-Dong, Xiao Hua-Liang, Wu Yan, Zhu Bo, Wang Ge, Yang Zhen-Zhou
机构信息
Cancer Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, 10 Changjiang Zhilu, Daping Yuzhong District, Chongqing, 400042, People's Republic of China.
Department of Oncology, Southwest Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China.
出版信息
BMC Cancer. 2017 Apr 4;17(1):245. doi: 10.1186/s12885-017-3165-0.
BACKGROUND
Central nervous system (CNS) brain metastasis of advanced non-small cell lung cancer (NSCLC) patients confers a worse quality of life and prognosis. The efficacy comparison of two first-generation epidermal growth factor receptor (EGFR) inhibitors erlotinib or gefitinib as first-line treatment for CNS metastasis NSCLC patients with EGFR-sensitizing mutations is yet to be elucidated.
METHODS
A retrospective analysis was done on cerebral metastasis rate after erlotinib or gefitinib as first-line treatment for advanced NSCLC patients with EGFR-sensitizing mutations. Time to neurological progression (nTTP) and median progression-free survival (mPFS) were calculated.
RESULTS
The study involved 279 patients (erlotinib group: 108, gefitinib group: 171). After a median follow-up of 22 months, 27 patients (25%) in the erlotinib group and 60 patients (35.1%) in the gefitinib group showed CNS progression. The HR of CNS progression for erlotinib versus gefitinib was 0.695 [95% confidence interval (CI), 0.406-1.190], suggesting a risk reduction of 30.5% although not achieving statistical significance. The 6-, 12- and 18-month cumulative CNS progression rates were 0.9, 3.7 and 12% for erlotinib compared with corresponding rates of 5.8, 9.4 and 17% for gefitinib (P = 0.181). However, for those patients with preexisting brain metastases prior to EGFR-TKI treatment, erlotinib as first line treatment significantly extended the median nTTP in comparison to gefitinib (30 months vs 15.8 months, p = 0.024).
CONCLUSIONS
Our data show that nTTP can be effectively extended in preexisting brain metastases patients with EGFR-sensitizing mutations initially treated with erlotinib compared with gefitinib. If confirmed, our results indicate that erlotinib may play an important role in controlling CNS progression from EGFR mutation-positive NSCLC.
背景
晚期非小细胞肺癌（NSCLC）患者发生中枢神经系统（CNS）脑转移会导致生活质量下降和预后变差。第一代表皮生长因子受体（EGFR）抑制剂厄洛替尼或吉非替尼作为EGFR敏感突变的CNS转移NSCLC患者一线治疗的疗效比较尚待阐明。
方法
对厄洛替尼或吉非替尼作为EGFR敏感突变的晚期NSCLC患者一线治疗后的脑转移率进行回顾性分析。计算至神经功能进展时间（nTTP）和中位无进展生存期（mPFS）。
结果
该研究纳入279例患者（厄洛替尼组：108例，吉非替尼组：171例）。中位随访22个月后，厄洛替尼组27例患者（25%）和吉非替尼组60例患者（35.1%）出现CNS进展。厄洛替尼与吉非替尼相比，CNS进展的风险比（HR）为0.695 [95%置信区间（CI），0.406 - 1.190]，提示风险降低30.5%，尽管未达到统计学显著性。厄洛替尼的6个月、12个月和18个月累积CNS进展率分别为0.9%、3.7%和12%，而吉非替尼相应的进展率分别为5.8%、9.4%和17%（P = 0.181）。然而，对于在EGFR-TKI治疗前已有脑转移的患者，与吉非替尼相比，厄洛替尼作为一线治疗显著延长了中位nTTP（30个月对15.8个月，p = 0.024）。
结论
我们的数据表明，与吉非替尼相比，对于初始接受厄洛替尼治疗的已有脑转移且具有EGFR敏感突变的患者，nTTP可有效延长。如果得到证实，我们的结果表明厄洛替尼可能在控制EGFR突变阳性NSCLC的CNS进展中发挥重要作用。
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