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一线 EGFR-TKI 治疗后局部进展的非小细胞肺癌(NSCLC)患者中,继续使用 EGFR-TKI 联合放疗以改善无进展生存期(TTP)。

Continued EGFR-TKI with concurrent radiotherapy to improve time to progression (TTP) in patients with locally progressive non-small cell lung cancer (NSCLC) after front-line EGFR-TKI treatment.

机构信息

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.

出版信息

Clin Transl Oncol. 2018 Mar;20(3):366-373. doi: 10.1007/s12094-017-1723-1. Epub 2017 Aug 3.


DOI:10.1007/s12094-017-1723-1
PMID:28776311
Abstract

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.

摘要

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。

相似文献

[1]
Continued EGFR-TKI with concurrent radiotherapy to improve time to progression (TTP) in patients with locally progressive non-small cell lung cancer (NSCLC) after front-line EGFR-TKI treatment.

Clin Transl Oncol. 2017-8-3

[2]
Concurrent EGFR-TKI and Thoracic Radiotherapy as First-Line Treatment for Stage IV Non-Small Cell Lung Cancer Harboring EGFR Active Mutations.

Oncologist. 2019-4-30

[3]
Continuation of epidermal growth factor receptor tyrosine kinase inhibitor treatment prolongs disease control in non-small-cell lung cancers with acquired resistance to EGFR tyrosine kinase inhibitors.

Oncotarget. 2015-9-22

[4]
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[5]
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BMC Cancer. 2016-2-24

[6]
[Efficacy of salvage chemotherapy in the advanced non-small cell lung cancer patients who failed the treatment of chemotherapy and EGFR-TKI].

Zhonghua Zhong Liu Za Zhi. 2010-11

[7]
Postoperative survival of EGFR-TKI-targeted therapy in non-small cell lung cancer patients with EGFR 19 or 21 mutations: a retrospective study.

World J Surg Oncol. 2017-11-6

[8]
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Jpn J Clin Oncol. 2012-3-28

[9]
T790M mutation is associated with better efficacy of treatment beyond progression with EGFR-TKI in advanced NSCLC patients.

Lung Cancer. 2014-3-15

[10]
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Cancer Chemother Pharmacol. 2015-10

引用本文的文献

[1]
Role of radiotherapy in advanced oncogenic-driven oligometastatic non-small cell lung cancer patients: a narrative review.

J Thorac Dis. 2025-6-30

[2]
Survival Outcomes in EGFR-Mutant Non-Small Cell Lung Cancer With Brain Metastases: Kaplan-Meier and Cox Regression Analyses Across Treatment Stages.

Clin Respir J. 2025-5

[3]
The Role of Local Therapy for Oligo-Progressive Disease in Oncogene-Addicted Non-Small-Cell Lung Cancer.

Adv Radiat Oncol. 2024-4-14

[4]
Non-Small Cell Lung Cancer Treatment with Molecularly Targeted Therapy and Concurrent Radiotherapy-A Review.

Int J Mol Sci. 2023-3-20

[5]
The role of brain radiotherapy for EGFR- and ALK-positive non-small-cell lung cancer with brain metastases: a review.

Radiol Med. 2023-3

[6]
Association between clinical outcomes and local treatment in stage IV non-small cell lung cancer patients with single extrathoracic metastasis.

Thorac Cancer. 2022-5

[7]
Identification of high expression profiles of miR-31-5p and its vital role in lung squamous cell carcinoma: a survey based on qRT-PCR and bioinformatics analysis.

Transl Cancer Res. 2019-6

[8]
Molecular Mechanism of EGFR-TKI Resistance in -Mutated Non-Small Cell Lung Cancer: Application to Biological Diagnostic and Monitoring.

Cancers (Basel). 2021-9-30

[9]
Effect of pemetrexed on the efficacy, toxic reaction, and survival rate of patients with EGFR-TKI resistant moderate and advanced lung cancer.

Am J Transl Res. 2021-7-15

[10]
EGFR-mutated stage IV non-small cell lung cancer: What is the role of radiotherapy combined with TKI?

Cancer Med. 2021-9

本文引用的文献

[1]
Local microwave ablation with continued EGFR tyrosine kinase inhibitor as a treatment strategy in advanced non-small cell lung cancers that developed extra-central nervous system oligoprogressive disease during EGFR tyrosine kinase inhibitor treatment: A pilot study.

Medicine (Baltimore). 2016-6

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Non-small-cell lung cancer cells combat epidermal growth factor receptor tyrosine kinase inhibition through immediate adhesion-related responses.

Onco Targets Ther. 2016-5-19

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J Thorac Oncol. 2016-5-23

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Drugs. 2016-5

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Cancer Med. 2016-6

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Onco Targets Ther. 2016-2-24

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Clinical Characteristics and Continued Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Administration in EGFR-mutated Non-Small Cell Lung Cancer with Skeletal Metastasis.

Cancer Res Treat. 2016-7

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First-Line Erlotinib Therapy Until and Beyond Response Evaluation Criteria in Solid Tumors Progression in Asian Patients With Epidermal Growth Factor Receptor Mutation-Positive Non-Small-Cell Lung Cancer: The ASPIRATION Study.

JAMA Oncol. 2016-3

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Lancet Oncol. 2015-9

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Transl Lung Cancer Res. 2014-4

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