Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
Target Oncol. 2019 Aug;14(4):423-431. doi: 10.1007/s11523-019-00649-1.
Whether epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) combined with chemotherapy can delay the occurrence of brain metastasis (BM) is unclear.
This retrospective study aimed to evaluate whether EGFR-TKIs combined with chemotherapy can delay BM and decrease the incidence of BM as initial progression.
The data of 100 patients with EGFR-mutant advanced lung adenocarcinoma were retrospectively reviewed. The patients had no BM at initial diagnosis, and BM occurred during the treatment. Patients received EGFR-TKI only or EGFR-TKI combined with chemotherapy. Intracranial progression-free survival (iPFS), systemic progression-free survival (PFS), and overall survival (OS) were evaluated.
The overall median OS was 39 months (95% confidence interval (CI), 35.6-42.4 months). The median OS of EGFR-TKI combined with chemotherapy and EGFR-TKI only are 41 months (95% CI 35.5-46.5 months) and 39 months (95% CI 36.8-41.2 months), respectively. Patients in the combination treatment group had longer PFS (16 vs. 10 months; P = 0.030) and iPFS (21 vs. 14 months; P = 0.026). Further, as initial progression, fewer patients developed BM in the combined treatment group compared with the EGFR-TKI-only group (30.6% vs. 52.9%, P = 0.002) with a hazard ratio of 0.64 (95% CI 0.43-0.96). After controlling for significant covariables in a multivariable model, the different treatment strategies were independently associated with improved iPFS.
In this retrospective analysis, EGFR-TKIs combined with chemotherapy could improve PFS. Further, the combined treatment could delay BM occurrence and decrease the incidence of BM as initial progression.
表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）联合化疗是否能延迟脑转移（BM）的发生尚不清楚。
本回顾性研究旨在评估 EGFR-TKI 联合化疗是否能延迟 BM 的发生并降低作为初始进展的 BM 的发生率。
回顾性分析了 100 例 EGFR 突变型晚期肺腺癌患者的数据。这些患者在初始诊断时无 BM，且在治疗过程中发生了 BM。患者接受 EGFR-TKI 单药治疗或 EGFR-TKI 联合化疗。评估颅内无进展生存期（iPFS）、系统无进展生存期（PFS）和总生存期（OS）。
总体中位 OS 为 39 个月（95%置信区间（CI）：35.6-42.4 个月）。EGFR-TKI 联合化疗和 EGFR-TKI 单药治疗的中位 OS 分别为 41 个月（95%CI 35.5-46.5 个月）和 39 个月（95%CI 36.8-41.2 个月）。联合治疗组的 PFS（16 个月比 10 个月；P=0.030）和 iPFS（21 个月比 14 个月；P=0.026）更长。此外，作为初始进展，联合治疗组中发生 BM 的患者比例明显低于 EGFR-TKI 单药治疗组（30.6%比 52.9%，P=0.002），风险比为 0.64（95%CI 0.43-0.96）。在多变量模型中控制了显著的协变量后，不同的治疗策略与改善 iPFS 独立相关。
在这项回顾性分析中，EGFR-TKIs 联合化疗可改善 PFS。此外，联合治疗可延迟 BM 的发生并降低作为初始进展的 BM 的发生率。
