Isobe Hiroshi, Mori Kiyoshi, Minato Koichi, Katsura Hideki, Taniguchi Kazuko, Arunachalam Ashwini, Kothari Smita, Cao Xiting, Kato Terufumi
Department of Medical Oncology, KKR Sapporo Medical Center, Hokkaido.
Department of Thoracic Diseases, Division of Thoracic Oncology, Tsuboi Cancer Center Hospital, Fukushima.
Lung Cancer (Auckl). 2017 Oct 24;8:191-206. doi: 10.2147/LCTT.S140491. eCollection 2017.
Recommended therapies for advanced/metastatic non-small cell lung cancer (NSCLC) have changed with the advent of targeted therapies. The objectives of this retrospective chart review study were to describe treatment patterns, biomarker testing practices, and health care resource use for advanced NSCLC at 5 sites in Japan.
We studied anonymized medical record data of patients aged ≥18 years who initiated systemic therapy for newly diagnosed stage IIIB or IV NSCLC from January 2011 through June 2013. Data were analyzed descriptively by histology and mutation status. Overall survival was estimated using the Kaplan-Meier method.
We studied 175 patients, including 43 (25%), 129 (74%), and 3 (2%) with squamous, nonsquamous, and unknown NSCLC histology, respectively; 83% had stage IV NSCLC. Overall, 123 patients (70%) were male; the median age was 70 years (range, 47-86); and 33 (19%) were never-smokers. In the nonsquamous cohort, 105 (81%) and 25 (19%) of patients were tested for epidermal growth factor receptor () mutation and anaplastic lymphoma kinase () rearrangement, respectively; 44 (42%) had -positive NSCLC and 2 (8%) had -positive NSCLC, including 26/46 (57%) women and 21/46 (46%) never-smokers. In the squamous cohort, 17 (40%) and 4 (9%), respectively, were tested; 1 -positive tumor was detected. After first-line therapy, 105 (60%) patients received second-line, and 54/105 (51%; or 31% overall) received third-line therapy. tyrosine kinase inhibitors were most commonly prescribed for -positive NSCLC across all lines. In the nonsquamous /-negative/unknown cohort, most received first-line platinum combinations, particularly younger patients (78% ≥75 years vs 93% <75 years old). The average hospitalization was 21 days/admission. The median (95% CI) overall survival from start of first-line therapy was 9.9 months (7.6-11.7) for all patients and 17.9 months (9.9-24.4) for patients with /-positive status.
Biomarker testing is common for nonsquamous NSCLC at the 5 Japanese study sites. Treatment is personalized by mutation status and age, per guideline recommendations.
随着靶向治疗的出现，晚期/转移性非小细胞肺癌（NSCLC）的推荐治疗方法发生了变化。这项回顾性病历审查研究的目的是描述日本5个地点晚期NSCLC的治疗模式、生物标志物检测方法以及医疗资源的使用情况。
我们研究了2011年1月至2013年6月期间开始接受新诊断的IIIB期或IV期NSCLC全身治疗的≥18岁患者的匿名医疗记录数据。数据按组织学和突变状态进行描述性分析。采用Kaplan-Meier方法估计总生存期。
我们研究了175例患者，其中分别有43例（25%）、129例（74%）和3例（2%）为鳞状、非鳞状和组织学不明的NSCLC；83%为IV期NSCLC。总体而言，123例患者（70%）为男性；中位年龄为70岁（范围47-86岁）；33例（19%）从不吸烟。在非鳞状队列中，分别有105例（81%）和25例（19%）患者接受了表皮生长因子受体（EGFR）突变检测和间变性淋巴瘤激酶（ALK）重排检测；44例（42%）为EGFR阳性NSCLC，2例（8%）为ALK阳性NSCLC，其中包括26/46（57%）女性和21/46（46%）从不吸烟者。在鳞状队列中，分别有17例（40%）和4例（9%）接受了检测；检测到1例EGFR阳性肿瘤。一线治疗后，105例（60%）患者接受了二线治疗，54/105例（51%；或总体31%）接受了三线治疗。EGFR酪氨酸激酶抑制剂在所有治疗线中最常用于EGFR阳性NSCLC。在非鳞状EGFR阴性/不明队列中，大多数患者接受一线铂类联合治疗，尤其是年轻患者（≥75岁患者中78% vs <75岁患者中93%）。平均住院时间为21天/次入院。从一线治疗开始的中位（95%CI）总生存期，所有患者为9.9个月（7.6-11.7），EGFR/ALK阳性状态患者为17.9个月（9.9-24.4）。
在日本的5个研究地点，生物标志物检测在非鳞状NSCLC中很常见。根据指南建议，治疗根据突变状态和年龄进行个性化调整。
