表皮生长因子受体酪氨酸激酶抑制剂与免疫检查点抑制剂治疗非小细胞肺癌术后复发的相对疗效。
Relative Efficacies of Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors for Treatment of Recurrent Non-Small Cell Lung Cancer after Surgery.
机构信息
Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan.
出版信息
Oncology. 2024;102(6):476-483. doi: 10.1159/000534814. Epub 2023 Nov 20.
INTRODUCTION
The relative efficacies of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and immune checkpoint inhibitors (ICIs) for the treatment of recurrent non-small cell lung cancer (NSCLC) after surgery remain unclear.
METHODS
Among 801 patients with NSCLC who underwent pulmonary resection at Kanazawa Medical University between 2017 and 2021, sixty-four patients had recurrence. We retrospectively compared the efficacies of EGFR-TKIs and ICIs in these patients with recurrent NSCLC who underwent pulmonary resection.
RESULTS
The 3-year overall survival rates after recurrence were 79.3% in patients who received EGFR-TKIs, 69.5% in patients who received ICIs, and 43.7% in patients who received cytotoxic agents. There was no significant difference in overall survival between patients treated with EGFR-TKIs and ICIs (p = 0.14) or between patients treated with ICIs and cytotoxic agents (p = 0.23), but overall survival was significantly higher in patients treated with EGFR-TKIs compared with cytotoxic agents (p < 0.01). The probabilities of a 2-year response were 88.5%, 61.6%, and 25.9% in patients treated with EGFR-TKIs, ICIs, and cytotoxic agents, respectively. There was no significant difference in response periods between patients treated with EGFR-TKIs and ICIs (p = 0.18), but the response period was significantly better in patients treated with EGFR-TKIs (p < 0.01) or ICIs (p = 0.03) compared with cytotoxic agents. Percent-predicted vital capacity (p = 0.03) and epidermal growth factor receptor gene mutation (p < 0.01) were significant factors affecting the overall response to chemotherapy in multivariate analysis.
CONCLUSION
EGFR-TKIs and ICIs are effective for treating recurrent NSCLC after surgery. Although adjuvant chemotherapy for completely resected pathological stage II to IIIA NSCLC, atezolizumab or osimertinib, has also been recently approved as adjuvant chemotherapy, there is a risk that patients who relapse after adjuvant chemotherapy will have less choice.
简介
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）和免疫检查点抑制剂（ICIs）治疗手术后复发性非小细胞肺癌（NSCLC）的相对疗效尚不清楚。
方法
在 2017 年至 2021 年间于金泽医科大学接受肺切除术的 801 例 NSCLC 患者中，有 64 例患者复发。我们回顾性比较了这些接受肺切除术的复发性 NSCLC 患者接受 EGFR-TKIs 和 ICIs 治疗的疗效。
结果
复发后 3 年的总生存率在接受 EGFR-TKIs 治疗的患者中为 79.3%，在接受 ICIs 治疗的患者中为 69.5%，在接受细胞毒性药物治疗的患者中为 43.7%。接受 EGFR-TKIs 和 ICIs 治疗的患者的总生存率无显著差异（p = 0.14），接受 ICIs 和细胞毒性药物治疗的患者的总生存率也无显著差异（p = 0.23），但与细胞毒性药物相比，接受 EGFR-TKIs 治疗的患者的总生存率显著更高（p < 0.01）。接受 EGFR-TKIs、ICIs 和细胞毒性药物治疗的患者的 2 年缓解率分别为 88.5%、61.6%和 25.9%。接受 EGFR-TKIs 和 ICIs 治疗的患者的缓解期无显著差异（p = 0.18），但与细胞毒性药物相比，接受 EGFR-TKIs（p < 0.01）或 ICIs（p = 0.03）治疗的患者的缓解期显著更好。预测肺活量百分比（p = 0.03）和表皮生长因子受体基因突变（p < 0.01）是多变量分析中影响化疗总体反应的显著因素。
结论
EGFR-TKIs 和 ICIs 对治疗手术后复发性 NSCLC 有效。尽管最近已批准完全切除病理分期 II 至 IIIA NSCLC 的辅助化疗、阿替利珠单抗或奥希替尼作为辅助化疗，但接受辅助化疗后复发的患者可能选择较少。
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