Inomata Minehiko, Kawashima Yosuke, Saito Ryota, Morinaga Daisuke, Nogawa Hitomi, Sato Masamichi, Suzuki Yohei, Yanagisawa Satoru, Kikuchi Takashi, Jingu Daisuke, Yoshimura Naruo, Harada Toshiyuki, Miyauchi Eisaku
First Department of Internal Medicine, Toyama University Hospital, Toyama 930-0194, Japan.
Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Miyagi 980-0873, Japan.
Oncol Lett. 2023 Jun 20;26(2):334. doi: 10.3892/ol.2023.13920. eCollection 2023 Aug.
The present multicenter study was performed to compare the efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) monotherapy with that of combined EGFR-TKI plus vascular endothelial growth factor receptor (VEGF) inhibitor/cytotoxic therapy in patients with programmed death-ligand 1 (PD-L1)-positive EGFR-mutant non-small cell lung cancer (NSCLC). Data from patients with PD-L1-positive EGFR-mutant NSCLC were collected from 12 institutes. Survival in patients treated with first- and second-generation EGFR-TKIs, osimertinib (third-generation EGFR-TKI), and combined EGFR-TKI plus VEGF inhibitor/cytotoxic therapy was analyzed by multiple regression analysis with adjustments for sex, performance status, EGFR mutation status, PD-L1 expression level, and the presence or absence of brain metastasis using a Cox proportional hazards model. Data from a total of 263 patients were analyzed, including 111 (42.2%) patients who had received monotherapy with a first- or second-generation EGFR-TKI, 132 (50.2%) patients who had received osimertinib monotherapy, and 20 (7.6%) patients who had received combined EGFR-TKI plus VEGF inhibitor/cytotoxic therapy (hereafter referred to as combined therapy). Multiple regression analysis using the Cox proportional hazards model showed that the hazard ratio (95% confidence interval) for progression-free survival was 0.73 (0.54-1.00) in the patients who had received osimertinib monotherapy and 0.47 (0.25-0.90) in patients who had received combined therapy. The hazard ratio for overall survival was 0.98 (0.65-1.48) in the patients who had received osimertinib monotherapy and 0.52 (0.21-1.31) in patients who had received combined therapy. In conclusion, combined therapy was associated with a significant reduction in the risk of progression compared with first- and second-generation EGFR-TKI monotherapy, and therefore, may be promising for the treatment of patients of NSCLC.
本多中心研究旨在比较表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）单药治疗与EGFR-TKI联合血管内皮生长因子受体（VEGF）抑制剂/细胞毒性疗法在程序性死亡配体1（PD-L1）阳性EGFR突变非小细胞肺癌（NSCLC）患者中的疗效。从12家机构收集了PD-L1阳性EGFR突变NSCLC患者的数据。使用Cox比例风险模型，通过对性别、体能状态、EGFR突变状态、PD-L1表达水平以及是否存在脑转移进行调整的多元回归分析，分析接受第一代和第二代EGFR-TKI、奥希替尼（第三代EGFR-TKI）以及EGFR-TKI联合VEGF抑制剂/细胞毒性疗法治疗患者的生存率。共分析了263例患者的数据，其中111例（42.2%）接受第一代或第二代EGFR-TKI单药治疗，132例（50.2%）接受奥希替尼单药治疗，20例（7.6%）接受EGFR-TKI联合VEGF抑制剂/细胞毒性疗法（以下简称联合疗法）。使用Cox比例风险模型的多元回归分析显示，接受奥希替尼单药治疗的患者无进展生存期的风险比（95%置信区间）为0.73（0.54 - 1.00），接受联合疗法的患者为0.47（0.25 - 0.90）。接受奥希替尼单药治疗的患者总生存期的风险比为0.98（0.65 - 1.48），接受联合疗法的患者为0.52（0.21 - 1.31）。总之，与第一代和第二代EGFR-TKI单药治疗相比，联合疗法与进展风险的显著降低相关，因此，可能对NSCLC患者的治疗具有前景。
