Department of Clinical Trial, Zhejiang Cancer Hospital, Hangzhou, China; Wenzhou Medical University, Wenzhou, China.
Department of Clinical Trial, Zhejiang Cancer Hospital, Hangzhou, China; Zhejiang Chinese Medical University, Hangzhou, China.
Clin Lung Cancer. 2023 Dec;24(8):717-725.e1. doi: 10.1016/j.cllc.2023.07.001. Epub 2023 Jul 5.
Combined small-cell lung cancer (c-SCLC) with gene mutations is a rare subtype often found alongside adenocarcinoma. Targeted therapy may be effective because of the presence of specific molecular targets. However, due to its rarity and unconventional genetic testing, the efficacy remains uncertain.
A total of 31 c-SCLC patients with gene mutations were retrospectively included and grouped according to their treatment regimens. Treatment outcomes were evaluated. Kaplan-Meier method was used for survival analysis, with Log Rank test applied for comparison between groups.
We divided the 31 patients into 3 groups according to first-line treatment: group A (chemotherapy, n = 16), group B (targeted monotherapy, n = 7), and group C (targeted combination therapy, n = 8). The overall response rates (ORR) were 43.8%, 42.9%, and 62.5%. The disease control rates (DCR) were 87.5%, 85.7%, and 100%. The median progression-free survival (PFS) was 4.0, 5.0, and 7.93 months (P = .024), with a significant difference between group A and C (P = .010). The median overall survival (OS) was 14.10, 17.43, and 12.93 months (P = .313). Seven patients in group A received targeted therapy in later-line. Of the total 22 patients received targeted monotherapy or combination therapy, the ORR and DCR were 54.5% and 90.9%. The median PFS and OS were 5.87 and 17.30 months. Additionally, adverse events (AEs) occurred in 53.8% and 88.9% of monotherapy and combination therapy. The most common AEs in monotherapy were elevated transaminases (23.1%) and in combination anemia (66.7%).
TKIs showed encouraging efficacy in driver-gene-positive c-SCLC. While monotherapy may be a supplementary option, combination with chemotherapy appears to be preferable and superior.
伴有基因突变的小细胞肺癌（c-SCLC）是一种罕见的亚型，常与腺癌共存。由于存在特定的分子靶点，靶向治疗可能有效。然而，由于其罕见性和非常规的基因检测，疗效仍不确定。
回顾性纳入 31 例伴有基因突变的 c-SCLC 患者，根据治疗方案进行分组。评估治疗结果。采用 Kaplan-Meier 法进行生存分析，组间比较采用 Log Rank 检验。
根据一线治疗，我们将 31 例患者分为 3 组：A 组（化疗，n=16）、B 组（靶向单药治疗，n=7）和 C 组（靶向联合治疗，n=8）。总体缓解率（ORR）分别为 43.8%、42.9%和 62.5%。疾病控制率（DCR）分别为 87.5%、85.7%和 100%。无进展生存期（PFS）中位数分别为 4.0、5.0 和 7.93 个月（P=0.024），A 组和 C 组之间有显著差异（P=0.010）。总生存期（OS）中位数分别为 14.10、17.43 和 12.93 个月（P=0.313）。A 组中有 7 例患者在后续线接受了靶向治疗。在总共接受靶向单药或联合治疗的 22 例患者中，ORR 和 DCR 分别为 54.5%和 90.9%。PFS 和 OS 中位数分别为 5.87 和 17.30 个月。此外，单药和联合治疗的不良事件（AE）发生率分别为 53.8%和 88.9%。单药治疗中最常见的 AE 是转氨酶升高（23.1%），联合治疗中最常见的 AE 是贫血（66.7%）。
TKIs 对驱动基因阳性的 c-SCLC 显示出令人鼓舞的疗效。虽然单药治疗可能是一种补充选择，但联合化疗似乎更优。
