Department of Medical Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P.R. China.
Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, P.R. China.
Ann Med. 2023;55(2):2257227. doi: 10.1080/07853890.2023.2257227.
To establish a risk stratification score to facilitate individualized treatment for patients with advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC).
We enrolled 160 advanced EGFR-mutated NSCLC who received first-generation EGFR-tyrosine kinase inhibitor (EGFR-TKI) with or without bevacizumab. Kaplan-Meier curves were used for survival analysis. Univariate and multivariate analyses were used to identify independent prognostic factors associated with progression-free survival (PFS) and overall survival (OS).
There were 107 patients in EGFR-TKI monotherapy (T group) and 53 patients in EGFR-TKI with bevacizumab (A + T group). The median PFS in the A + T group was significantly longer than that in the T group ( = 0.002). No difference in the median OS between the A + T and T groups ( = 0.721). The multivariate analyses showed that Eastern Cooperative Oncology Group performance status (ECOG PS) and the pre-treatment lactate dehydrogenase-albumin ratio (LAR) were independent prognostic factors for PFS and OS. The LAR-ECOG PS (LAPS) score was constructed by combining the pre-treatment LAR and ECOG PS. We defined ECOG PS 2 and high pre-treatment LAR as a score of 1. Then, patients with a total LAPS score of 0 were categorized as low-risk and those with 1-2 scores were classified as high-risk. For patients in low-risk group, there was no significant difference in PFS, OS, objective response rate (ORR), and disease control rate (DCR) among those who received EGFR-TKI with or without bevacizumab. However, patients in high-risk group had a significant benefit in PFS and DCR when treated with EGFR-TKI plus bevacizumab compared to those who received EGFR-TKI alone.
Novel LAPS score may help to facilitate individualized treatment of advanced EGFR-mutated NSCLC receiving EGFR-TKI with or without bevacizumab.
为了对接受第一代表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（EGFR-TKI）治疗的晚期 EGFR 突变型非小细胞肺癌（NSCLC）患者进行个体化治疗，建立风险分层评分。
我们纳入了 160 名接受第一代 EGFR-TKI 联合或不联合贝伐珠单抗治疗的晚期 EGFR 突变型 NSCLC 患者。采用 Kaplan-Meier 曲线进行生存分析。采用单因素和多因素分析确定与无进展生存期（PFS）和总生存期（OS）相关的独立预后因素。
107 名患者接受 EGFR-TKI 单药治疗（T 组），53 名患者接受 EGFR-TKI 联合贝伐珠单抗治疗（A+T 组）。A+T 组的中位 PFS 明显长于 T 组（=0.002）。A+T 组与 T 组的中位 OS 无差异（=0.721）。多因素分析显示，东部肿瘤协作组体能状态（ECOG PS）和治疗前乳酸脱氢酶-白蛋白比值（LAR）是 PFS 和 OS 的独立预后因素。结合治疗前 LAR 和 ECOG PS 构建 LAR-ECOG PS（LAPS）评分。我们将 ECOG PS 2 和高治疗前 LAR 定义为 1 分。然后，总 LAPS 评分 0 的患者被归类为低危，总 LAPS 评分 1-2 的患者被归类为高危。对于低危组患者，接受 EGFR-TKI 联合或不联合贝伐珠单抗治疗的患者之间，PFS、OS、客观缓解率（ORR）和疾病控制率（DCR）无显著差异。然而，高危组患者接受 EGFR-TKI 联合贝伐珠单抗治疗较单独接受 EGFR-TKI 治疗在 PFS 和 DCR 方面获益更显著。
新型 LAPS 评分有助于对接受 EGFR-TKI 联合或不联合贝伐珠单抗治疗的晚期 EGFR 突变型 NSCLC 患者进行个体化治疗。
