Wang Xiaomeng, Chen Jin, Yao Jiaqi, Guo Renhua
Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Nanjing Medical University, Nanjing 211166, China.
Zhongguo Fei Ai Za Zhi. 2018 Jan 20;21(1):37-42. doi: 10.3779/j.issn.1009-3419.2018.01.10.
Epidermal growth factor receptor (EGFR) mutation non-small cell lung cancer (NSCLC) is an important subtype of lung cancer. The incidence of malignant pericardial effusion (MPCE) in EGFR-mutant NSCLC patients is high. However, there are few researches on the treatmentof this type of patients.
We collected data on clinical characteristics and treatment of advanced NSCLC patients who harboring EGFR mutants and MPCE between January 2010 and December 2016. The treatments were divided into three groups: oral gefitinib combined with pericardial perfusion of hydroxycamptotheci (HCPT) group (gefitinib/HCPT); intravenous chemotherapy combined with pericardial perfusion of HCPT group (chemotherapy/HCPT) and gefitinib monotherapy group. And we retrospectively analyzed patients' outcomes in three groups.
In 273 advanced NSCLC patients with EGFR mutations, 29 cases had pericardial effusion, among which 6 patients with small amount of pericardial effusion were excluded, and 23 patients were analyzed. Median pericardium progression free survival (PFS) was 247 days. PFS for gefitinib/HCPT group (460 days) was superior to PFS for chemotherapy/HCPT group (94 days, P=0.008) and gefitinib monotherapy group (131 days, P=0.032). As for the efficacy of primary pulmonary lesions, the efficacy in gefitinib/ HCPT group was superior to chemotherapy/HCPT group [objective response rate (ORR): 33.3% vs 12.5%; disease control rate (DCR): 86.7% vs 62.5%]. There is no difference of ORR and DCR between gefitinib/HCPT group and gefitinib monotherapy group. No obvious adverse reaction was observed in all three groups.
First-line gefitinib therapy combined with pericardial perfusion of HCPT can improve pericardium PFS for advanced NSCLC patients who harboring EGFR mutants andmalignantpericardial effusion. This finding should be confirmed further through multicenter, prospective clinical trials with large sample size.
表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）是肺癌的一种重要亚型。EGFR突变型NSCLC患者发生恶性心包积液（MPCE）的发生率较高。然而，针对这类患者的治疗研究较少。
我们收集了2010年1月至2016年12月期间携带EGFR突变且发生MPCE的晚期NSCLC患者的临床特征和治疗数据。治疗分为三组：口服吉非替尼联合心包腔内灌注羟基喜树碱（HCPT）组（吉非替尼/HCPT）；静脉化疗联合心包腔内灌注HCPT组（化疗/HCPT）和吉非替尼单药治疗组。我们回顾性分析了三组患者的治疗结果。
在273例携带EGFR突变的晚期NSCLC患者中，29例出现心包积液，其中6例心包积液量少的患者被排除，共23例患者纳入分析。心包无进展生存期（PFS）的中位数为247天。吉非替尼/HCPT组的PFS（460天）优于化疗/HCPT组（94天，P = 0.008）和吉非替尼单药治疗组（131天，P = 0.032）。对于原发性肺部病变的疗效，吉非替尼/HCPT组的疗效优于化疗/HCPT组[客观缓解率（ORR）：33.3%对12.5%；疾病控制率（DCR）：86.7%对62.5%]。吉非替尼/HCPT组与吉非替尼单药治疗组之间的ORR和DCR无差异。三组均未观察到明显不良反应。
一线吉非替尼治疗联合心包腔内灌注HCPT可改善携带EGFR突变且发生恶性心包积液的晚期NSCLC患者的心包PFS。这一发现应通过多中心、大样本量的前瞻性临床试验进一步证实。
