奥希替尼联合颅脑放疗对比奥希替尼单药用于 EGFR 激活突变合并脑转移的 NSCLC 患者的疗效：一项回顾性研究。
Therapeutic effect of osimertinib plus cranial radiotherapy compared to osimertinib alone in NSCLC patients with EGFR-activating mutations and brain metastases: a retrospective study.
机构信息
Shantou University Medical College, Shantou, 515041, Guangdong Province, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
出版信息
Radiat Oncol. 2021 Dec 5;16(1):233. doi: 10.1186/s13014-021-01955-7.
BACKGROUND
The study aimed to compare the efficacy of osimertinib plus cranial radiotherapy (RT) with osimertinib alone in advanced non-small-cell lung cancer (NSCLC) patients harboring epidermal growth factor receptor (EGFR) mutations and brain metastases (BMs).
METHODS
The clinical data of advanced NSCLC patients with BMs who received osimertinib were retrospectively collected. The patients were assigned to one of the two groups according to the therapeutic modality used: the osimertinib monotherapy group or the osimertinib plus RT group.
RESULTS
This was a retrospective study and 61 patients were included from December 2015 to August 2020. Forty patients received osimertinib monotherapy, and twenty-one patients received osimertinib plus RT. Radiotherapy included whole-brain radiation therapy (WBRT, n = 14), WBRT with simultaneous integrated boost (WBRT-SIB, n = 5) and stereotactic radiosurgery (SRS, n = 2). The median number of prior systemic therapies in the two groups was one. Intracranial and systemic ORR and DCR were not significantly different between the two groups. No difference in iPFS was observed between the two groups (median iPFS: 16.67 vs. 13.50 months, P = 0.836). The median OS was 29.20 months in the osimertinib plus RT group compared with 26.13 months in the osimertinib group (HR = 0.895, P = 0.826). In the L858R mutational subgroup of 31 patients, the osimertinib plus RT group had a longer OS (P = 0.046). In the exon 19 deletion mutational subgroup of 30 patients, OS in the osimertinib alone group was longer than that in the osimertinib plus RT group (P = 0.011). The incidence of any-grade adverse events was not significantly different between the osimertinib plus RT group and the osimertinib alone group (47.6% vs. 32.5%, P = 0.762). However, six patients (28.5%) experienced leukoencephalopathy in the osimertinib plus RT group, and 50% (3/6) of the leukoencephalopathy was greater than or equal to grade 3.
CONCLUSION
The therapeutic effect of osimertinib with RT was similar to that of osimertinib alone in EGFR-positive NSCLC patients with BM. However, for patients with the L858R mutation, osimertinib plus RT could provide more benefit than osimertinib alone.
背景
本研究旨在比较奥希替尼联合颅放疗（RT）与奥希替尼单药治疗表皮生长因子受体（EGFR）突变型伴脑转移（BMs）的晚期非小细胞肺癌（NSCLC）患者的疗效。
方法
回顾性收集接受奥希替尼治疗的晚期 NSCLC 伴 BM 患者的临床资料。根据治疗方式将患者分为两组：奥希替尼单药组或奥希替尼联合 RT 组。
结果
这是一项回顾性研究，纳入 2015 年 12 月至 2020 年 8 月的 61 例患者。40 例患者接受奥希替尼单药治疗，21 例患者接受奥希替尼联合 RT。放疗包括全脑放疗（WBRT，n=14）、WBRT 同步整合推量（WBRT-SIB，n=5）和立体定向放疗（SRS，n=2）。两组患者的中位预处理全身治疗次数均为 1 次。两组颅内和全身客观缓解率（ORR）和疾病控制率（DCR）无显著差异。两组间无进展生存期（iPFS）差异无统计学意义（中位 iPFS：16.67 个月 vs. 13.50 个月，P=0.836）。奥希替尼联合 RT 组的中位总生存期（OS）为 29.20 个月，奥希替尼组为 26.13 个月（HR=0.895，P=0.826）。在 31 例 L858R 突变亚组中，奥希替尼联合 RT 组的 OS 更长（P=0.046）。在 30 例 exon19 缺失突变亚组中，奥希替尼单药组的 OS 长于奥希替尼联合 RT 组（P=0.011）。奥希替尼联合 RT 组与奥希替尼单药组不良反应发生率无显著差异（47.6% vs. 32.5%，P=0.762）。然而，奥希替尼联合 RT 组 6 例（28.5%）患者发生放射性脑损伤，50%（3/6）为≥3 级放射性脑损伤。
结论
对于 EGFR 阳性 NSCLC 伴 BM 患者，奥希替尼联合 RT 的疗效与奥希替尼单药相似。然而，对于 L858R 突变患者，奥希替尼联合 RT 可能比奥希替尼单药更有益。
Zotero 插件