Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Internal Medicine Oncology, The First Affiliated Hospital of University of South China, Hengyang, Hunan Province, China.
Cancer Med. 2023 Jan;12(1):266-273. doi: 10.1002/cam4.4894. Epub 2022 Jun 5.
Epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) develops resistance to tyrosine kinase inhibitors (TKIs). Here, we evaluated the efficacy of radiotherapy and continuation of TKIs in patients with advanced NSCLC with oligoprogression after EGFR-TKIs.
From January 2011 to January 2019, 33 patients with EGFR-mutated NSCLC on TKIs were treated by radiotherapy and continuation of TKIs for oligoprogressive disease. The primary endpoints were median progression-free survival 1 (mPFS1), mPFS2, and median overall survival (mOS). PFS1 was measured from the start of EGFR-TKIs therapy to the oligoprogression of the disease. PFS2 was measured from the date of oligoprogression to the further progression of the disease, while OS was calculated from oligoprogression to death from any cause or was censored at the last follow-up date.
The mPFS1, mPFS2, and mOS were 11.0 (95% CI, 4.4-17.6), 6.5 (95% CI, 1.4-11.6) and 21.8 (95% CI, 14.8-28.8) months, respectively. Univariate analysis showed that EGFR mutation type (p = 0.024), radiotherapy method (p = 0.001), and performance status (p = 0.017) were significantly correlated with PFS2. Univariate analysis showed that sex (p = 0.038), smoking history (p = 0.031), EGFR mutation type (p = 0.012), and radiotherapy method (p = 0.009) were significantly correlated with OS. Multivariate analysis suggested that radiotherapy method (p = 0.001) and performance status (p = 0.048) were prognostic factors for PFS2, and radiotherapy method (p = 0.040) was a prognostic factor for OS.
Radiotherapy with continued TKIs is effective for EGFR-mutated NSCLC with oligoprogression, and it should be conducted as soon as possible. T790M+ patients have higher sensitivity to radiotherapy, and patients with good performance status and stereotactic body radiation therapy have better PFS2 and OS.
表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）对酪氨酸激酶抑制剂（TKI）产生耐药性。在这里，我们评估了在 EGFR-TKI 治疗后出现寡进展的晚期 NSCLC 患者中，放射治疗和继续 TKI 治疗的疗效。
从 2011 年 1 月至 2019 年 1 月，对 33 例接受 EGFR 突变型 NSCLC 患者进行放射治疗和继续 TKI 治疗，以治疗寡进展性疾病。主要终点是中位无进展生存期 1（mPFS1）、mPFS2 和中位总生存期（mOS）。PFS1 从 EGFR-TKIs 治疗开始到疾病的寡进展进行测量。PFS2 从寡进展的日期到疾病的进一步进展进行测量，而 OS 从寡进展到任何原因导致的死亡或从最后一次随访日期截止进行计算。
mPFS1、mPFS2 和 mOS 分别为 11.0（95%CI，4.4-17.6）、6.5（95%CI，1.4-11.6）和 21.8（95%CI，14.8-28.8）个月。单因素分析表明，EGFR 突变类型（p=0.024）、放射治疗方法（p=0.001）和表现状态（p=0.017）与 PFS2 显著相关。单因素分析表明，性别（p=0.038）、吸烟史（p=0.031）、EGFR 突变类型（p=0.012）和放射治疗方法（p=0.009）与 OS 显著相关。多因素分析表明，放射治疗方法（p=0.001）和表现状态（p=0.048）是 PFS2 的预后因素，放射治疗方法（p=0.040）是 OS 的预后因素。
EGFR 突变型 NSCLC 出现寡进展时，继续进行 TKI 联合放射治疗是有效的，应尽快进行。T790M+患者对放射治疗更敏感，表现状态良好和立体定向体部放射治疗的患者具有更好的 PFS2 和 OS。
