放疗联合表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗非小细胞肺癌脑转移患者的疗效与安全性：已发表数据的荟萃分析

Efficacy and Safety of Radiotherapy Plus EGFR-TKIs in NSCLC Patients with Brain Metastases: A Meta-Analysis of Published Data.

作者信息

Wang Xueyan, Xu Ye, Tang Weiqing, Liu Lingxiang

机构信息

Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.

Division of Surgery, Guilin Medical University, Guilin, Guangxi, 541000, China.

出版信息

Transl Oncol. 2018 Oct;11(5):1119-1127. doi: 10.1016/j.tranon.2018.07.003. Epub 2018 Jul 20.

BACKGROUND

The role of radiotherapy (RT) combined with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) remains controversial. Therefore, we conducted a meta-analysis to comprehensively evaluate the efficacy and safety of RT plus EGFR-TKIs in those patients.

MATERIALS AND METHODS

Relevant literatures published between 2012 and 2017 were searched. Objective response rate(ORR), disease control rate (DCR), overall survival (OS), intracranial progression-free survival (I-PFS) and adverse events (AEs) were extracted. The combined hazard ratios (HRs) and relative risks (RRs) were calculated using random effects models.

RESULTS

Twenty-four studies (2810 patients) were included in the analysis. Overall, RT plus EGFR-TKIs had higher ORR (RR = 1.32, 95%CI: 1.13-1.55), DCR (RR = 1.12, 95%CI: 1.04-1.22), and longer OS (HR = 0.72, 95%CI: 0.59-0.89), I-PFS (HR = 0.64, 95%CI: 0.50-0.82) than monotherapy, although with higher overall AEs (20.2% vs 11.8%, RR = 1.34, 95% CI: 1.11-1.62). Furthermore, subgroup analyses found concurrent RT plus EGFR-TKIs could prolong OS (HR = 0.69, 95%CI: 0.55-0.86) and I-PFS (HR = 0.57, 95%CI: 0.44-0.75). Asian ethnicity and lung adenocarcinoma (LAC) patients predicted a more favorable prognosis (HR = 0.69,95%CI: 0.54-0.88, HR = 0.66, 95%CI: 0.53-0.83, respectively).

CONCLUSION

RT plus EGFR-TKIs had higher response rate, longer OS and I-PFS than monotherapy in NSCLC patients with BM. Asian LAC patients with EGFR mutation had a better prognosis with concurrent treatment. The AEs of RT plus EGFR-TKIs were tolerated.

背景

放射治疗（RT）联合表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）在非小细胞肺癌（NSCLC）脑转移（BM）患者中的作用仍存在争议。因此，我们进行了一项荟萃分析，以全面评估RT联合EGFR-TKIs在这些患者中的疗效和安全性。

材料与方法

检索2012年至2017年间发表的相关文献。提取客观缓解率（ORR）、疾病控制率（DCR）、总生存期（OS）、颅内无进展生存期（I-PFS）和不良事件（AE）。使用随机效应模型计算合并风险比（HRs）和相对风险（RRs）。

结果

分析纳入了24项研究（2810例患者）。总体而言，与单一疗法相比，RT联合EGFR-TKIs具有更高的ORR（RR = 1.32，95%CI：1.13 - 1.55）、DCR（RR = 1.12，95%CI：1.04 - 1.22），以及更长的OS（HR = 0.72，95%CI：0.59 - 0.89）、I-PFS（HR = 0.64，95%CI：0.50 - 0.82），尽管总体不良事件发生率更高（20.2%对11.8%，RR = 1.34，95%CI：1.11 - 1.62）。此外，亚组分析发现同步RT联合EGFR-TKIs可延长OS（HR = 0.69，95%CI：0.55 - 0.86）和I-PFS（HR = 0.57，95%CI：0.44 - 0.75）。亚洲人种和肺腺癌（LAC）患者预后更佳（HR分别为0.69,95%CI：0.54 - 0.88和HR = 0.66，95%CI：0.53 - 0.83）。