Kapoor Akhil, Noronha Vanita, Joshi Amit, Patil Vijay M, Menon Nandini, Bollam Rajesh, Talreja Vikas, Goud Supriya, More Sucheta, Solanki Leena, Shah Srushti, Chougule Anuradha, Mahajan Abhishek, Prabhash Kumar
Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh 221005 India.
The first two authors contributed equally to the manuscript.
Ecancermedicalscience. 2021 Aug 5;15:1274. doi: 10.3332/ecancer.2021.1274. eCollection 2021.
A significant proportion of non-small cell lung cancer (NSCLC) patients present with poor performance status (PS) at baseline are almost always excluded from the clinical trials leading to availability of only limited data in this subgroup.
This was an observational single institutional study. The eligibility criteria for inclusion were a histologic or cytologic diagnosis of advanced NSCLC and Eastern Cooperative Oncology Group PS 3 or 4. All patients coming between June 2015 and December 2018 were evaluated for inclusion in this study.
A total of 245 patients were enrolled in the study. The median age of the patients was 63 years (range 25-89), 142 (58%) were male, 196 (80%) had adenocarcinoma histology and 192 (78.4%) has PS 3 while rest (21.6%) had PS 4. Out of 245 patients, 192 (78.4%) received oral tyrosine kinase inhibitors (TKI) and supportive care, 45 (18.4%) received supportive care alone, while 8 (3.2%) patients received chemotherapy along with supportive care. Median overall survival (OS) was 3 months (95% CI: 1.8-4.2) in patients who received oral TKI versus 1 month (1.0-2.9) in patients who received supportive care alone (log-rank = 0.013). The median OS for epidermal growth factor receptor (EGFR) mutant patients who received oral TKI was 12 months (95% CI: 7.7-16.3), while it was 3 months (95% CI: 1.5-4.5) for patients who were EGFR wild-type and received TKI on compassionate basis (HR = 0.50; 95% CI: 0.32-0.77; = 0.001).
The use of oral TKI on a compassionate basis led to improvement in survival in the overall cohort of the patients; this was principally driven by EGFR-mutated patients.
相当一部分基线时表现状态（PS）较差的非小细胞肺癌（NSCLC）患者几乎总是被排除在临床试验之外，导致该亚组仅有有限的数据。
这是一项单机构观察性研究。纳入标准为组织学或细胞学确诊的晚期NSCLC且东部肿瘤协作组（ECOG）PS为3或4。对2015年6月至2018年12月期间前来就诊的所有患者进行评估以确定是否纳入本研究。
本研究共纳入245例患者。患者的中位年龄为63岁（范围25 - 89岁），142例（58%）为男性，196例（80%）组织学类型为腺癌，192例（78.4%）PS为3，其余（21.6%）PS为4。在245例患者中，192例（78.4%）接受口服酪氨酸激酶抑制剂（TKI）及支持治疗，45例（18.4%）仅接受支持治疗，8例（3.2%）患者接受化疗及支持治疗。接受口服TKI的患者中位总生存期（OS）为3个月（95%CI：1.8 - 4.2），而仅接受支持治疗的患者中位OS为1个月（1.0 - 2.9）（对数秩检验 = 0.013）。接受口服TKI的表皮生长因子受体（EGFR）突变患者的中位OS为12个月（95%CI：7.7 - 16.3），而EGFR野生型且在同情用药基础上接受TKI治疗的患者中位OS为3个月（95%CI：1.5 - 4.5）（HR = 0.50；95%CI：0.32 - 0.77；P = 0.001）。
在同情用药基础上使用口服TKI可提高患者总体队列的生存率；这主要由EGFR突变患者驱动。
