Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuma Street, Jinan District, Fuzhou, 350014, China.
Clin Transl Oncol. 2024 Dec;26(12):3202-3210. doi: 10.1007/s12094-024-03543-z. Epub 2024 Jun 9.
This retrospective analysis aimed to evaluate the efficacy and adverse reactions of metronomic oral vinorelbine and its combination therapy as second- and later-line regimens for advanced non-small-cell lung cancer (NSCLC).
NSCLC patients undergoing metronomic oral vinorelbine as second- and later-line regimens in Fujian Cancer Hospital from October 2018 to October 2022 were enrolled, and patients' demographic and clinical characteristics were collected. The efficacy and safety of metronomic oral vinorelbine monotherapy and its combination therapy regimens were compared.
Of 57 study subjects, 63.2% received third- and later-line therapy, with median progression-free survival (mPFS) of 4 months, overall response rate (ORR) of 10.5%, and disease control rate (DCR) of 80.7%. The incidence of therapy-related adverse events was 42.1%, and there was only one case presenting grades 3 and 4 adverse events (1.8%). Among driver gene-negative participants, vinorelbine combination therapy regimens achieved longer mPFS (4.6 vs. 1.2 months, hazards ratio = 0.11, P < 0.0001) and comparable toxicity in relative to metronomic oral vinorelbine, and metronomic oral vinorelbine combined with immune checkpoint inhibitors showed the highest response, with mPFS of 5.6 months (95% CI 4.8 to 6.4 months), ORR of 25%, and DCR of 81.3%. Among participants with gradual resistance to osimertinib, continuing osimertinib in combination with metronomic oral vinorelbine achieved mPFS of 6.3 months (95% CI 0.1 to 12.5 months) and DCR of 86.7%.
Metronomic oral vinorelbine and its combination therapy regimens are favorable options as second- and later-line therapy for advanced NSCLC patients, with acceptable efficacy and tolerable toxicity. Vinorelbine combination therapy regimens show higher efficacy and comparable toxicity in relative to metronomic oral vinorelbine, and metronomic oral vinorelbine may have a synergistic effect with immunotherapy and EGFR-TKI targeted therapy.
本回顾性分析旨在评估节拍口服长春瑞滨及其联合治疗方案作为晚期非小细胞肺癌（NSCLC）二线及以上治疗的疗效和不良反应。
纳入 2018 年 10 月至 2022 年 10 月在福建省肿瘤医院接受节拍口服长春瑞滨二线及以上治疗的 NSCLC 患者，收集患者的人口统计学和临床特征。比较节拍口服长春瑞滨单药及联合治疗方案的疗效和安全性。
57 例研究对象中，63.2%接受三线及以上治疗，中位无进展生存期（mPFS）为 4 个月，总缓解率（ORR）为 10.5%，疾病控制率（DCR）为 80.7%。治疗相关不良反应发生率为 42.1%，仅 1 例出现 3-4 级不良反应（1.8%）。在驱动基因阴性患者中，长春瑞滨联合治疗方案较节拍口服长春瑞滨的 mPFS 更长（4.6 个月 vs. 1.2 个月，风险比=0.11，P<0.0001），毒性相当，而节拍口服长春瑞滨联合免疫检查点抑制剂的缓解率最高，mPFS 为 5.6 个月（95%CI 4.8-6.4 个月），ORR 为 25%，DCR 为 81.3%。在奥希替尼逐渐耐药的患者中，继续奥希替尼联合节拍口服长春瑞滨的 mPFS 为 6.3 个月（95%CI 0.1-12.5 个月），DCR 为 86.7%。
节拍口服长春瑞滨及其联合治疗方案作为晚期 NSCLC 患者二线及以上治疗的选择具有较好的疗效和可接受的毒性。长春瑞滨联合治疗方案较节拍口服长春瑞滨具有更高的疗效和相当的毒性，节拍口服长春瑞滨可能与免疫治疗和 EGFR-TKI 靶向治疗具有协同作用。
