Zheng Zhen, Xie Deyao, Su Huafang, Lin Baochai, Zhao Lihao, Deng Xia, Chen Hanbin, Fei Shaoran, Jin Xiance, Xie Congying
1 Department of Radiotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
2 Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Tumour Biol. 2017 Jun;39(6):1010428317706211. doi: 10.1177/1010428317706211.
Recent studies demonstrated a significantly increased frequency of epidermal growth factor receptor (EGFR) gene mutations in non-small cell lung cancer (NSCLC) patients with malignant pleural effusions (MPEs). The purpose of this study is to investigate the effect of first-line and second-line EGFR-tyrosine kinase inhibitors (TKIs) in the treatment of NSCLC with MPEs harboring exon 19 deletion and L858R mutation. From 2010 to 2015, 203 NSCLC patients with MPEs harboring EGFR mutation treated with EGFR-TKIs were reviewed. The efficacy were evaluated with Pearson chi-square or Fisher's exact tests, Log-rank test and Cox proportional hazards model. The objective response rate (ORR) and disease control rate (DCR) for patients treated with first-line and second-line EGFR-TKIs were 21.9%, 91.4% and 14.7%, 85.3%, respectively. The overall median PFS and OS of enrolled NSCLC patients with MPE were 9.3 months (95% CI, 8.4-10.2 months), 20.9 months (95% CI, 18.9-22.9 months) after first-line TKIs, and 7.6 months (95% CI, 6.6-8.6 months), 15.3 months (95% CI, 13.6-15.9 months) after second-line TKIs. The exon 19 deletion arm had a longer median PFS (9.4 vs 7.1 months, p=0.003) and OS (16.8 vs 13.8 months, p=0.003) compared with the L858R mutation arm after second-line TKIs. In a conclusion, EGFR genotype was an independent predictor of PFS and OS. No significant side effects differences between the two mutation groups was observed for first or second-line EGFR-TKIs. This study demonstrated that EGFR mutations are significant predictors for advanced NSCLC patients with MPE receiving second-line EGFR-TKIs treatment.
近期研究表明，在伴有恶性胸腔积液（MPE）的非小细胞肺癌（NSCLC）患者中，表皮生长因子受体（EGFR）基因突变的频率显著增加。本研究的目的是探讨一线和二线EGFR酪氨酸激酶抑制剂（TKI）对伴有外显子19缺失和L858R突变的NSCLC合并MPE患者的治疗效果。回顾了2010年至2015年期间接受EGFR-TKI治疗的203例伴有EGFR突变的NSCLC合并MPE患者。采用Pearson卡方检验或Fisher精确检验、Log-rank检验和Cox比例风险模型评估疗效。一线和二线EGFR-TKI治疗患者的客观缓解率（ORR）和疾病控制率（DCR）分别为21.9%、91.4%和14.7%、85.3%。入组的NSCLC合并MPE患者一线TKI治疗后的总中位无进展生存期（PFS）和总生存期（OS）分别为9.3个月（95%CI，8.4-10.2个月）、20.9个月（95%CI，18.9-22.9个月），二线TKI治疗后分别为7.6个月（95%CI，6.6-8.6个月）、15.3个月（95%CI，13.6-15.9个月）。二线TKI治疗后，外显子19缺失组的中位PFS（9.4对7.1个月，p=0.003）和OS（16.8对13.8个月，p=0.003）均长于L858R突变组。总之，EGFR基因型是PFS和OS的独立预测因素。一线或二线EGFR-TKI治疗在两个突变组之间未观察到显著的副作用差异。本研究表明，EGFR突变是晚期NSCLC合并MPE患者接受二线EGFR-TKI治疗的重要预测因素。
