Wang Wenxian, Jiang Xiaowen, Zhang Yiping, Song Yong, Song Zhengbo
Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou 310022, China.
Zhejiang Cancer Hospital, Hangzhou 310022, China.
J Thorac Dis. 2019 Sep;11(9):3712-3720. doi: 10.21037/jtd.2019.09.36.
Epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) patients benefit from EGFR-tyrosine kinase inhibitors (TKIs) therapy. There are few studies comparing the efficacy between intrapleural chemotherapy combination with TKIs and TKIs alone in controlling re-accumulation of malignant pleural effusions (MPEs). The purpose of the study was to determine if patients with EGFR-mutated NSCLC and MPEs would benefit from intrapleural chemotherapeutics with an oral EGFR-TKI than EGFR-TKI alone.
We evaluated -mutated lung cancer patients with MPEs in Zhejiang Cancer Hospital. We evaluated the efficacy. Progression-free survival (PFS) and overall survival (OS) was evaluated by Kaplan-Meier method.
One hundred one NSCLC patients with MPEs at the time of diagnosis were included. We divided the patients into two groups. The overall response rate (ORR) with respect to MPE recurrence between the TKI alone and combination therapy groups was 65.5% (38/58) and 58.1% (25/43) (P=0.449). The disease control rate was 89.7% (52/58) and 86.0% (37/43) (P=0.579), respectively. The PFS in the TKI alone and TKI plus intrapleural drugs was 10.3 and 9.9 months, respectively (P=0.746). The intrapleural PFS was 11.4 and 11.0 months for the TKI alone and combination groups, respectively (P=0.188). The OS was 24.9 and 22.6 months (P=0.543), respectively. Hematologic toxicity and chest pain were more frequent in the combination therapy than TKI alone groups.
Intrapleural chemotherapy with TKI did not improve the efficacy of controlling MPEs in patients with EGFR-mutated NSCLC, but may increase adverse events, which are typical side effects of chemotherapy. We could treat these patients with TKI drugs alone combined with pleural effusion drainage.
表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者可从EGFR酪氨酸激酶抑制剂（TKIs）治疗中获益。比较胸腔内化疗联合TKIs与单纯TKIs在控制恶性胸腔积液（MPEs）再积聚方面疗效的研究较少。本研究的目的是确定EGFR突变的NSCLC合并MPEs患者接受胸腔内化疗联合口服EGFR-TKI是否比单纯使用EGFR-TKI更有益。
我们评估了浙江省肿瘤医院的EGFR突变型肺癌合并MPEs患者。我们评估了疗效。采用Kaplan-Meier法评估无进展生存期（PFS）和总生存期（OS）。
纳入101例诊断时合并MPEs的NSCLC患者。我们将患者分为两组。单纯TKI组和联合治疗组MPE复发的总缓解率（ORR）分别为65.5%（38/58）和58.1%（25/43）（P = 0.449）。疾病控制率分别为89.7%（52/58）和86.0%（37/43）（P = 0.579）。单纯TKI组和TKI加胸腔内药物组的PFS分别为10.3个月和9.9个月（P = 0.746）。单纯TKI组和联合组的胸腔内PFS分别为11.4个月和11.0个月（P = 0.188）。OS分别为24.9个月和22.6个月（P = 0.543）。联合治疗组的血液学毒性和胸痛比单纯TKI组更常见。
TKI胸腔内化疗并未提高EGFR突变型NSCLC患者控制MPEs的疗效，但可能增加不良事件，这些是化疗的典型副作用。我们可以单独用TKI药物联合胸腔积液引流来治疗这些患者。
