系统性类固醇对晚期胃肠道间质瘤（GIST）患者一线伊马替尼治疗疗效的影响。
Impact of systemic steroids on the efficacy of first line imatinib treatment of patients with advanced gastrointestinal stromal tumors (GISTs).
机构信息
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
出版信息
BMC Cancer. 2024 Oct 8;24(1):1245. doi: 10.1186/s12885-024-13032-9.
BACKGROUND
Effective management of adverse events is required to maintain sufficient imatinib dosing when treating patients with gastrointestinal stromal tumors (GISTs). Skin rash is a common adverse event of imatinib, which can be effectively controlled by systemic steroid treatment without imatinib dose modification or interruption. However, the impact of the use of systemic steroids on the efficacy of imatinib treatment remains unclear.
METHODS
Between October 2014 and February 2022, 277 consecutive patients from a prospective registry of GIST patients were included as the study population. Patients who started systemic steroids due to grade ≥ 3 skin rash or grade 2 skin rash with grade 2 pruritis were classified as the steroid group, whereas patients who did not develop a skin rash or those who did not require steroids for a mild skin rash were classified as the control group. Efficacy outcomes were compared between the two groups.
RESULTS
Among the 277 patients, 30 (10.8%) were treated with systemic steroids for skin rash. There was no significant difference in progression free survival (PFS) or overall survival (OS) between the steroid and control groups (3-year PFS, 67.7% vs. 65.1%, p = 0.53; 3-year OS, 91% vs. 89.9%, p = 0.67, respectively). The use of systemic steroids was not an independent factor associated with PFS (hazard ratio 0.73, 95% confidence interval 0.36-1.49, p = 0.39) and OS (hazard ratio 0.37, 95% confidence interval 0.12-1.18, p = 0.09). In the steroid group, patients who successfully maintained the imatinib dosage showed a trend toward more favorable survival outcomes than those who did not (3-year PFS, 73.3% vs. 44.4%, p = 0.34; 3-year OS, 95.8% vs. 75.0%, p = 0.15, respectively).
CONCLUSIONS
The use of systemic steroids for the control of imatinib induced severe skin rash did not adversely affect the efficacy outcomes of imatinib in patients with advanced GIST.
背景
胃肠道间质瘤（GIST）患者的治疗需要有效管理不良反应，以维持充分的伊马替尼剂量。皮疹是伊马替尼的常见不良反应，系统使用皮质类固醇治疗可有效控制，无需调整或中断伊马替尼剂量。然而，皮质类固醇的使用对伊马替尼治疗效果的影响尚不清楚。
方法
2014 年 10 月至 2022 年 2 月，连续纳入 277 例来自 GIST 患者前瞻性登记研究的患者作为研究对象。因 3 级或 2 级皮疹伴 2 级瘙痒而开始系统使用皮质类固醇的患者归入皮质类固醇组，未发生皮疹或仅因轻度皮疹而无需使用皮质类固醇的患者归入对照组。比较两组患者的疗效。
结果
277 例患者中，30 例（10.8%）因皮疹接受系统皮质类固醇治疗。皮质类固醇组与对照组之间的无进展生存期（PFS）或总生存期（OS）无显著差异（3 年 PFS，67.7%比 65.1%，p=0.53；3 年 OS，91%比 89.9%，p=0.67）。系统使用皮质类固醇不是与 PFS（风险比 0.73，95%置信区间 0.36-1.49，p=0.39）和 OS（风险比 0.37，95%置信区间 0.12-1.18，p=0.09）相关的独立因素。在皮质类固醇组中，成功维持伊马替尼剂量的患者的生存结果有改善趋势，优于未成功维持剂量的患者（3 年 PFS，73.3%比 44.4%，p=0.34；3 年 OS，95.8%比 75.0%，p=0.15）。
结论
控制伊马替尼诱导的严重皮疹使用皮质类固醇并未对晚期 GIST 患者的伊马替尼疗效产生不利影响。
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