Lee I-Hsien, Yang Ching-Yao, Shih Jin-Yuan, Yu Chong-Jen
Department of Emergency and Critical Care Medicine, Fu-Jen Catholic University Hospital, New Taipei City 24308, Taiwan.
Division of Thoracic Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei 10225, Taiwan.
Biomedicines. 2021 Oct 8;9(10):1416. doi: 10.3390/biomedicines9101416.
Respiratory failure requiring mechanical ventilation is the major reason for lung cancer patients being admitted to the intensive care unit (ICU). Though molecular targeted therapies, especially epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs), have largely improved the survival of oncogene-driven lung cancer patients, few studies have focused on the performance of TKI in such settings.
This was a retrospective cohort study enrolling non-small cell lung cancer (NSCLC) patients who harbored sensitizing EGFR mutation and had received EGFR-TKIs as first-line cancer therapy in the ICU with mechanical ventilator use. The primary outcome was the 28-day ICU survival rate, and secondary outcomes were the rate of successful weaning from the ventilator and overall survival.
A total of 35 patients were included. The 28-day ICU survival rate was 77%, and the median overall survival was 67 days. Multivariate logistic regression revealed that shock status was associated with a lower 28-day ICU survival rate independently (odds ratio (OR) 0.017, 95% confidence interval (CI), 0.000-0.629, = 0.027), and that L858R mutation (L858R compared with exon 19 deletion, OR, 0.014, 95% CI 0.000-0.450, = 0.016) and comorbidities of diabetes mellitus (DM) (OR, 0.032, 95% CI, 0.000-0.416, = 0.014)) were independently predictive of weaning failure. The successful weaning rate was 43%, and the median of ventilator-dependent duration was 22 days (IQR, 12-29).
For EGFR mutant lung cancer patients suffering from respiratory failure and undergoing mechanical ventilation, TKI may still be useful, especially in those with EGFR del19 mutation or without shock and DM comorbidity.
需要机械通气的呼吸衰竭是肺癌患者入住重症监护病房（ICU）的主要原因。尽管分子靶向治疗，尤其是表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKIs），在很大程度上提高了致癌基因驱动的肺癌患者的生存率，但很少有研究关注TKIs在这种情况下的表现。
这是一项回顾性队列研究，纳入了非小细胞肺癌（NSCLC）患者，这些患者携带敏感的EGFR突变，并在ICU中接受EGFR-TKIs作为一线癌症治疗且使用了机械通气。主要结局是28天ICU生存率，次要结局是呼吸机成功撤机率和总生存率。
共纳入35例患者。28天ICU生存率为77%，中位总生存期为67天。多因素逻辑回归显示，休克状态独立与较低的28天ICU生存率相关（比值比（OR）0.017，95%置信区间（CI），0.000 - 0.629，P = 0.027），L858R突变（L858R与外显子19缺失相比，OR，0.014，95% CI 0.000 - 0.450，P = 0.016）和糖尿病（DM）合并症（OR，0.032，95% CI，0.000 - 0.416，P = 0.014）独立预测撤机失败。成功撤机率为43%，呼吸机依赖持续时间的中位数为22天（四分位间距，12 - 29）。
对于患有呼吸衰竭并接受机械通气的EGFR突变肺癌患者，TKI可能仍然有用，尤其是对于那些具有EGFR del19突变或没有休克和DM合并症的患者。
