Department of Oncology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
Department of Gastroenterology, First People's Hospital of Liangjiang New District, Chongqing, 400020, China.
Clin Transl Oncol. 2018 Mar;20(3):366-373. doi: 10.1007/s12094-017-1723-1. Epub 2017 Aug 3.
BACKGROUND: Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is the optimal treatment for EGFR-mutant advanced non-small cell lung cancer (NSCLC). However, most patients developed systemic or local progression due to acquired EGFR-TKI resistance. This retrospective study aimed to evaluate the feasibility of continued EGFR-TKI with concurrent radiotherapy (CTCRT) in patients with local progression after front-line EGFR-TKI treatment. METHODS: Advanced NSCLC patients with active EGFR mutation who received EGFR-TKI were treated with CTCRT after local progression. Medical data were analyzed for time to progression (TTP), progression-free survival (PFS), tumor response rate, overall survival (OS) and adverse events. RESULTS: A total of 50 irradiated lesions from 44 patients were included. Median TTP and PFS of measurable lesions (n = 31) were both significantly prolonged after local radiotherapy (TTP1 + TTP2 vs. TTP1: 21.7 vs. 16.0 months, P = 0.010; PFS1 + PFS2 vs. PFS1: 21.3 vs. 16.0 months, P = 0.027). For all lesions (n = 50), objective response rate (ORR) and local tumor control rate (LCR) were 54.0 and 84.0%, respectively. Median OS was 26.6 months. There were no serious adverse events before or after radiotherapy. CONCLUSIONS: The treatment modality of CTCRT is considerable and effective for EGFR-mutant NSCLC patients even with local failure from front-line EGFR-TKI treatment.
背景:表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)是治疗表皮生长因子受体(EGFR)突变型晚期非小细胞肺癌(NSCLC)的最佳选择。然而,大多数患者由于获得性 EGFR-TKI 耐药而出现全身或局部进展。本回顾性研究旨在评估一线 EGFR-TKI 治疗后局部进展的患者继续使用表皮生长因子受体酪氨酸激酶抑制剂联合放射治疗(CTCRT)的可行性。
方法:接受 EGFR-TKI 治疗的具有活跃 EGFR 突变的晚期 NSCLC 患者,在局部进展后接受 CTCRT 治疗。对无进展生存期(PFS)、肿瘤客观缓解率、总生存期(OS)和不良事件的进展时间(TTP)、疾病进展时间(TTP)、PFS、肿瘤客观缓解率、总生存期(OS)和不良事件进行分析。
结果:共纳入 44 例患者的 50 个放疗病灶。可测量病灶(n=31)的中位 TTP 和 PFS 在局部放疗后均显著延长(TTP1+TTP2 vs. TTP1:21.7 vs. 16.0 个月,P=0.010;PFS1+PFS2 vs. PFS1:21.3 vs. 16.0 个月,P=0.027)。所有病灶(n=50)的客观缓解率(ORR)和局部肿瘤控制率(LCR)分别为 54.0%和 84.0%。中位 OS 为 26.6 个月。放疗前后均无严重不良事件。
结论:即使在一线 EGFR-TKI 治疗后出现局部失败,CTCRT 治疗方式对 EGFR 突变型 NSCLC 患者也是可行且有效的。
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