Department of Pneumology and Respiratory Functional Exploration, University Hospital of Tours.
INSERM, Centre d'Etude des Pathologies Respiratoires, Tours, France.
Anticancer Drugs. 2024 Aug 1;35(7):672-679. doi: 10.1097/CAD.0000000000001609. Epub 2024 Mar 22.
Osimertinib has become the standard of care for epidermal growth factor receptor ( EGFR )-mutated non-small cell lung cancer (NSCLC). In order to prevent or treat toxicity, the osimertinib dose may be reduced. However, data regarding the impact of dose reduction during treatment are limited. We aimed to compare the efficacy of osimertinib early dose reduction during the first 3 months of treatment with late dose reduction in EGFR -mutated advanced NSCLC. This retrospective study included patients with EGFR -mutated advanced NSCLC who received osimertinib. We constituted two groups: 'early dose reduction' (early) with patients receiving a reduced dose of osimertinib from 80 to 40 mg within the 3 months of osimertinib initiation and 'late dose reduction' (late) with patients receiving a reduced dose after 3 months of full-dose treatment. Thirty-five patients were included, with 17 and 18 patients in the early and late groups, respectively, and a higher median age in the early group (76 vs. 67 years). The real-world progression-free survival (rwPFS) at 1 year was 70.5% in the early group and 88.9% in the late group ( P = 0.31). Median rwPFS was 32.7 and 24.6 months ( P = 0.98), and the median overall survival was 46.9 versus not reached in early and late groups, respectively ( P = 0.17). Central nervous system rwPFS was not different between the early and late groups: 29.8 and 35.8 months, respectively ( P = 0.39). We showed that a reduced dose of osimertinib within the first 3 months of treatment, compared to a later reduced dose, could influence treatment response or patient survival.
奥希替尼已成为表皮生长因子受体 (EGFR) 突变型非小细胞肺癌 (NSCLC) 的标准治疗方法。为了预防或治疗毒性，可能会减少奥希替尼的剂量。然而，关于治疗期间减少剂量的影响的数据有限。我们旨在比较 EGFR 突变型晚期 NSCLC 患者在治疗的头 3 个月内早期减少奥希替尼剂量与晚期减少奥希替尼剂量的疗效。这项回顾性研究纳入了接受奥希替尼治疗的 EGFR 突变型晚期 NSCLC 患者。我们将患者分为两组：“早期剂量减少”（早期），即奥希替尼起始后 3 个月内将奥希替尼剂量从 80mg 减少至 40mg；“晚期剂量减少”（晚期），即全剂量治疗 3 个月后减少奥希替尼剂量。共纳入 35 例患者，其中早期组 17 例，晚期组 18 例，早期组患者的中位年龄较高（76 岁 vs. 67 岁）。早期组和晚期组的真实世界无进展生存期（rwPFS）在 1 年时分别为 70.5%和 88.9%（P=0.31）。中位 rwPFS 分别为 32.7 个月和 24.6 个月（P=0.98），中位总生存期分别为 46.9 个月和未达到（P=0.17）。早期组和晚期组中枢神经系统 rwPFS 无差异：分别为 29.8 个月和 35.8 个月（P=0.39）。我们表明，与晚期减少剂量相比，治疗的前 3 个月内减少奥希替尼剂量可能会影响治疗反应或患者生存。
