Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Cancer Med. 2024 Apr;13(7):e7152. doi: 10.1002/cam4.7152.
This study aimed to examine the clinical characteristics of bone metastasis (BoM) in patients with non-small cell lung cancer (NSCLC) who have an epidermal growth factor receptor (EGFR) mutation and to identify the most effective treatment strategy using EGFR-tyrosine kinase inhibitors (TKIs).
The study included patients with stage IV EGFR-mutated NSCLC who were receiving first-line treatment with EGFR-TKIs between January 2014 and December 2020. These patients were divided into two groups based on the presence or absence of BoM at the time of initial diagnosis. The BoM group was further subdivided based on whether they received denosumab or not.
The final analysis included 247 patients. Those with BoM at initial diagnosis had shorter progression-free survival (12.6 vs. 10.5 months, p = 0.002) and overall survival (OS) (49.7 vs. 30.9 months, p = 0.002) compared to those without BoM. There was a difference in the location of metastatic sites between the two groups, with a higher incidence of extrathoracic metastasis in the BoM group (p < 0.001). The incidence of T790M was higher in patients with BoM than in those without (47.4% vs. 33.9%, p = 0.042). Multivariate Cox regression analysis revealed that sequential osimertinib treatment and the addition of antiangiogenic therapy (AAT) and denosumab therapy improved OS in patients with BoM.
The presence of BoM is a negative prognostic factor for NSCLC patients with an EGFR mutation, possibly due to the presence of extrathoracic metastases. However, adding AAT and denosumab, along with sequential osimertinib, to the treatment regimen for patients with BoM can improve survival outcomes.
本研究旨在探讨表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者中骨转移（BoM）的临床特征，并确定使用 EGFR 酪氨酸激酶抑制剂（TKI）的最有效治疗策略。
本研究纳入了 2014 年 1 月至 2020 年 12 月期间接受一线 EGFR-TKI 治疗的 IV 期 EGFR 突变型 NSCLC 患者。这些患者根据初诊时是否存在 BoM 分为两组。BoM 组根据是否接受地舒单抗进一步细分。
最终分析纳入了 247 例患者。初诊时存在 BoM 的患者无进展生存期（12.6 个月 vs. 10.5 个月，p=0.002）和总生存期（OS）（49.7 个月 vs. 30.9 个月，p=0.002）均短于无 BoM 的患者。两组患者的转移部位存在差异，BoM 组的胸外转移发生率较高（p<0.001）。BoM 患者的 T790M 发生率高于无 BoM 患者（47.4% vs. 33.9%，p=0.042）。多因素 Cox 回归分析显示，序贯奥希替尼治疗以及添加抗血管生成治疗（AAT）和地舒单抗治疗可改善 BoM 患者的 OS。
BoM 的存在是 EGFR 突变 NSCLC 患者的一个负性预后因素，可能与胸外转移的存在有关。然而，在 BoM 患者的治疗方案中添加 AAT 和地舒单抗，以及序贯奥希替尼治疗，可以改善生存结局。
