Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan,
Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Japan.
Oncology. 2020;98(9):661-668. doi: 10.1159/000507050. Epub 2020 May 28.
Currently, combination therapy of ramucirumab (RAM) + docetaxel (DOC) must play a more important role as a second-line treatment. Epithelial growth factor receptor (EGFR) mutation accounts for around 50% of oncogenic driver mutations in patients with advanced non-small cell lung cancer (NSCLC) in Asian subsets. The number of brain metastases (BM) is relatively higher in EGFR mutation-positive patients compared to EGFR wild-type patients. The objective of this study is to evaluate the efficacy of RAM + DOC focusing on EGFR mutation and BM.
We retrospectively reviewed consecutive advanced NSCLC patients who received combination therapy of RAM + DOC at three institutions. A total of 112 patients with NSCLC were enrolled for efficacy analyses. We evaluated the efficacy of RAM + DOC for EGFR-mutated NSCLC with endpoints including progression-free survival (PFS), time to treatment failure (TTF) and overall survival.
Median PFS was 5.7 months for the EGFR mutant group compared with 3.6 months for the EGFR wild-type group (HR 0.53, 95% CI 0.32-0.87; p = 0.01). Median TTF was 5.1 months for the EGFR mutant group compared with 2.8 months for the EGFR wild-type group (HR 0.53, 95% CI 0.33-0.85; p = 0.007). Median PFS and TTF of the EGFR mutant group was significantly longer than median PFS and TTF of the EGFR wild-type group. The multivariate analysis identified EGFR mutation status as an independent favorable factor of PFS. In subset analyses of BM, median PFS of the EGFR mutant group (2.8 months) was significantly shorter than that of the EGFR wild-type group (5.1 months) (HR 7.27, 95% CI 1.78-29.68; p = 0.002).
This study revealed that EGFR mutation status and BM might be predictive or prognostic factors for PFS.
目前，雷莫芦单抗（RAM）+多西他赛（DOC）联合治疗作为二线治疗必须发挥更重要的作用。表皮生长因子受体（EGFR）突变约占亚洲亚组晚期非小细胞肺癌（NSCLC）患者致癌驱动突变的 50%。与 EGFR 野生型患者相比，EGFR 突变阳性患者的脑转移（BM）数量相对较高。本研究旨在评估 RAM+DOC 联合治疗针对 EGFR 突变和 BM 的疗效。
我们回顾性分析了三家机构连续接受 RAM+DOC 联合治疗的晚期 NSCLC 患者。共有 112 例 NSCLC 患者纳入疗效分析。我们评估了 RAM+DOC 联合治疗对 EGFR 突变型 NSCLC 的疗效，终点包括无进展生存期（PFS）、治疗失败时间（TTF）和总生存期。
EGFR 突变组的中位 PFS 为 5.7 个月，EGFR 野生型组为 3.6 个月（HR 0.53，95%CI 0.32-0.87；p = 0.01）。EGFR 突变组的中位 TTF 为 5.1 个月，EGFR 野生型组为 2.8 个月（HR 0.53，95%CI 0.33-0.85；p = 0.007）。EGFR 突变组的中位 PFS 和 TTF 明显长于 EGFR 野生型组的中位 PFS 和 TTF。多变量分析确定 EGFR 突变状态是 PFS 的独立有利因素。在 BM 的亚组分析中，EGFR 突变组的中位 PFS（2.8 个月）明显短于 EGFR 野生型组（5.1 个月）（HR 7.27，95%CI 1.78-29.68；p = 0.002）。
本研究表明，EGFR 突变状态和 BM 可能是 PFS 的预测或预后因素。
