Jiang Tao, Li Aiwu, Su Chunxia, Li Xuefei, Zhao Chao, Ren Shengxiang, Zhou Caicun, Zhang Jun
Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, P.R. China.
Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China.
Oncotarget. 2017 Mar 9;8(37):62648-62657. doi: 10.18632/oncotarget.16061. eCollection 2017 Sep 22.
This study aimed to investigate the role of bevacizumab in patients with advanced non-small cell lung cancer (NSCLC) who had developed acquired resistance to EGFR-TKIs therapy that manifested as malignant pleural effusion (MPE). In total, 86 patients were included. 47 patients received bevacizumab plus continued EGFR-TKIs and 39 patients received bevacizumab plus chemotherapy. The curative efficacy rate for MPE in bevacizumab plus EGFR-TKIs group was significantly higher than that in bevacizumab plus chemotherapy group (89.4% . 64.1%, respectively; = 0.005). Patients in bevacizumab plus EGFR-TKIs group had longer progression-free survival (PFS) than those in bevacizumab plus chemotherapy group (median PFS 6.3 . 4.8 months, = 0.042). While patients with acquired T790M mutation in bevacizumab plus EGFR-TKIs group had a significantly longer PFS than those in bevacizumab plus chemotherapy group (median PFS 6.9 . 4.6 months, = 0.022), patients with negative T790M had similar PFS (median PFS 6.1 . 5.5 months, = 0.588). Overall survival (OS) was similar between two groups ( = 0.480). In multivariate analysis, curative efficacy was an independent prognostic factor (HR 0.275, = 0.047). In conclusion bevacizumab plus EGFR-TKIs could be a valuable treatment for NSCLC patients presenting with MPE upon resistant to EGFR-TKIs therapy, especially for those with acquired T790M mutation.
本研究旨在探讨贝伐单抗在对表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗产生获得性耐药且表现为恶性胸腔积液（MPE）的晚期非小细胞肺癌（NSCLC）患者中的作用。总共纳入了86例患者。47例患者接受贝伐单抗加持续EGFR-TKIs治疗，39例患者接受贝伐单抗加化疗。贝伐单抗加EGFR-TKIs组MPE的疗效显著高于贝伐单抗加化疗组（分别为89.4%和64.1%；P = 0.005）。贝伐单抗加EGFR-TKIs组患者的无进展生存期（PFS）长于贝伐单抗加化疗组（中位PFS 6.3对4.8个月，P = 0.042）。虽然贝伐单抗加EGFR-TKIs组中获得性T790M突变的患者PFS显著长于贝伐单抗加化疗组（中位PFS 6.9对4.6个月，P = 0.022），但T790M阴性的患者PFS相似（中位PFS 6.1对5.5个月，P = 0.588）。两组的总生存期（OS）相似（P = 0.480）。多因素分析显示，疗效是独立的预后因素（风险比0.275，P = 0.047）。总之，对于对EGFR-TKIs治疗耐药且出现MPE的NSCLC患者，贝伐单抗加EGFR-TKIs可能是一种有价值的治疗方法，尤其是对于那些获得性T790M突变的患者。
