Liu Xiaoke, Hong Lingzhi, Nilsson Monique, Hubert Shawna Marie, Wu Shuhong, Rinsurongkawong Waree, Lewis Jeffery, Spelman Amy, Roth Jack, Swisher Steven, He Yong, Jack Lee J, Fang Bingliang, Heymach John V, Zhang Jianjun, Le Xiuning
Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, USA; Department of Thoracic Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, USA.
Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, USA.
Lung Cancer. 2020 Nov;149:33-40. doi: 10.1016/j.lungcan.2020.08.023. Epub 2020 Sep 9.
Osimertinib is the treatment of choice for advanced EGFR-mutant non-small cell lung cancer (NSCLC). However, novel strategies to improve the duration of disease control are still urgently needed. Aspirin has been shown to decrease cancer incidence and improve outcomes in various malignancies. Therefore, we evaluated a cohort of patients who received osimertinib with or without concurrent use of aspirin to assess whether the addition of aspirin may lead to improved clinical outcomes.
MD Anderson Cancer Center GEMINI database was retrospectively queried for EGFR-mutant NSCLC patients who received osimertinib with or without concurrent use of aspirin for progression-free survival (PFS) and overall survival (OS).
A total of 365 patients were identified including 77 which had concurrent use of aspirin. Patients in the aspirin-osimertinib group had significantly improved PFS (21.3 vs 11.6 months; HR, 0.52; 95 % CI, 0.38-0.70) and OS (Not reached vs 32.3 months; HR, 0.56; 95 % CI, 0.35-0.91) compared to osimertinib group. In subgroup analyses, the aspirin-associated PFS benefit was observed in patients with and without central nervous system (CNS) metastases, as well as in osimertinib first-line setting and in subsequent line setting. The median PFS in EGFR 19Del patients was longer than EGFR L858R patients with osimertinib, and when aspirin was added, the median PFS significantly improved in both groups regardless of lines of therapy. The benefit from aspirin was independent of age, gender, TP53 mutational status, or PD-L1 positivity.
Concurrent aspirin use with osimertinib in EGFR-mutant NSCLC patients was associated with improved survival, regardless of lines of therapy, CNS metastatic status, EGFR mutation type, age, gender, TP53, and PD-L1 status.
奥希替尼是晚期表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）的治疗选择。然而，仍迫切需要新的策略来延长疾病控制时间。阿司匹林已被证明可降低癌症发病率并改善各种恶性肿瘤的预后。因此，我们评估了一组接受奥希替尼治疗且同时使用或不使用阿司匹林的患者，以评估添加阿司匹林是否可能改善临床结局。
对MD安德森癌症中心的GEMINI数据库进行回顾性查询，以获取接受奥希替尼治疗且同时使用或不使用阿司匹林的EGFR突变NSCLC患者的无进展生存期（PFS）和总生存期（OS）。
共确定了365例患者，其中77例同时使用了阿司匹林。与奥希替尼组相比，阿司匹林-奥希替尼组患者的PFS（21.3个月对11.6个月；风险比[HR]，0.52；95%置信区间[CI]，0.38-0.70）和OS（未达到对32.3个月；HR，0.56；95%CI，0.35-0.91）显著改善。在亚组分析中，无论有无中枢神经系统（CNS）转移的患者，以及在奥希替尼一线治疗和后续治疗中，均观察到阿司匹林相关的PFS获益。EGFR 19号外显子缺失（EGFR 19Del）患者使用奥希替尼时的中位PFS长于EGFR L858R患者，添加阿司匹林后，两组无论治疗线数，中位PFS均显著改善。阿司匹林的获益与年龄、性别、TP53突变状态或程序性死亡受体配体1（PD-L1）阳性无关。
在EGFR突变的NSCLC患者中，奥希替尼与阿司匹林同时使用可提高生存率，无论治疗线数、CNS转移状态、EGFR突变类型、年龄、性别、TP53和PD-L1状态如何。
