Syahruddin Elisna, Huswatun Aida Lufti, Prabowo Ari, Zaini Jamal, Nurwidya Fariz, Hudoyo Achmad, Jusuf Anwar
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia, Persahabatan National Respiratory Referral Hospital, Jalan Persahabatan Raya No. 1, Rawamangun,Jakarta, Indonesia.
Department of Radiotherapy, Persahabatan National Respiratory Referral Hospital, Jalan Persahabatan Raya No. 1, Rawamangun,Jakarta, Indonesia.
Rom J Intern Med. 2018 Sep 1;56(3):173-181. doi: 10.2478/rjim-2018-0011.
Combinations of gefitinib and radiotherapy have been observed to have synergistic and anti-proliferative effects on lung cancer in vitro. In the clinical setting, patients who presented with respiratory difficulties such as superior vena cava syndrome (SVCS), radiotherapy should be given immediately to address the emergency while waiting for the results of epidermal growth factor receptor (EGFR) mutation test. However, there has been no study that described the role of radio-therapy in Indonesian patients with EGFR-mutant lung adenocarcinoma.
This preliminary study aimed to evaluate the efficacy and toxicities of gefitinib and radiotherapy combination in lung adenocarcinoma patients in Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia. Subjects were consecutively recruited between January 2013 and December 2016.
Thirty-one lung adenocarcinoma with EGFR mutations were enrolled. Most of them were male (51.61%) with a median age of 54.5 years old (range 38-70 years old). EGFR mutation characteristics were on exon 21 L858R point mutation (61.30%), exon 21 L861Q point mutation (16.12%) and exon 19 deletion (22.58%). Radiotherapy was given at doses between 30-60 Gy. Among these subjects, median progression-free survival (PFS) was 185 days (95%CI; 123.69 - 246.30), 1-year survival rate (1-yr) was 45.2%, and median overall survival (OS) was 300 days (95%CI; 130.94 - 469.06). There were no grade 3/4 hematological and nonhematological toxicities recorded. The most frequent grade 1 and 2 non-hematological toxicities were skin rash, diarrhea, and paronychia that might be related to tyrosine kinase inhibitor (TKI).
The combination of TKI with radiation may be considered in EGFR-mutant lung adenocarcinoma subjects.
在体外实验中，已观察到吉非替尼与放疗联合使用对肺癌具有协同和抗增殖作用。在临床环境中，对于出现诸如上腔静脉综合征（SVCS）等呼吸困难的患者，在等待表皮生长因子受体（EGFR）突变检测结果的同时，应立即给予放疗以解决紧急情况。然而，尚无研究描述放疗在印度尼西亚EGFR突变型肺腺癌患者中的作用。
这项初步研究旨在评估在印度尼西亚雅加达Persahabatan国家呼吸转诊医院的肺腺癌患者中，吉非替尼与放疗联合使用的疗效和毒性。研究对象在2013年1月至2016年12月期间连续招募。
纳入了31例具有EGFR突变的肺腺癌患者。其中大多数为男性（51.61%），中位年龄为54.5岁（范围38 - 70岁）。EGFR突变特征为外显子21 L858R点突变（61.30%）、外显子21 L861Q点突变（16.12%）和外显子19缺失（22.58%）。放疗剂量为30 - 60 Gy。在这些受试者中，中位无进展生存期（PFS）为185天（95%CI；123.69 - 246.30），1年生存率（1-yr）为45.2%，中位总生存期（OS）为300天（95%CI；130.94 - 469.06）。未记录到3/4级血液学和非血液学毒性。最常见的1级和2级非血液学毒性是皮疹、腹泻和甲沟炎，可能与酪氨酸激酶抑制剂（TKI）有关。
对于EGFR突变型肺腺癌患者，可考虑TKI与放疗联合使用。
