Yamaguchi Yoh, Shinno Yuki, Masuda Ken, Ariyasu Ryo, Nosaki Kaname, Hakozaki Taiki, Tokito Takaaki, Nomura Shogo, Nishio Makoto, Goto Koichi, Hosomi Yukio, Azuma Koichi, Ohe Yuichiro
Department of Thoracic Oncology, National Cancer Center Hospital, 104-0045, Japan; Cancer Medicine, Cooperative Graduate School, The Jikei University Graduate School of Medicine, Tokyo, Minato-ku, Tokyo, 105-8461, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital, 104-0045, Japan.
Curr Probl Cancer. 2025 Jun;56:101200. doi: 10.1016/j.currproblcancer.2025.101200. Epub 2025 Apr 4.
Non-small cell lung cancer (NSCLC) with driver mutations, notably epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase, shows reduced sensitivity to immune checkpoint inhibitors. A subgroup analysis of the IMpower150 data on patients resistant to EGFR tyrosine kinase inhibitors (EGFR-TKI) before enrollment demonstrated prolonged progression-free survival (PFS) with atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) over bevacizumab, carboplatin, and paclitaxel. However, due to the exploratory nature and small sample size, the efficacy of ABCP post-EGFR-TKI failure is still debated. We evaluated ABCP therapy against other platinum-based regimens without immune checkpoint inhibitors in terms of effectiveness and toxicity.
Data from patients with advanced or recurrent NSCLC harboring EGFR-sensitizing mutations treated with platinum-based chemotherapy or ABCP at five Japanese hospitals were retrospectively analyzed. Propensity score matching compared efficacy outcomes, including overall response rate (ORR), PFS, and OS.
Of 183 EGFR mutation carriers, 33 underwent ABCP therapy, while 150 received platinum-based chemotherapy. Following propensity score matching, 32 and 74 patients were analyzed. In the ABCP group, median PFS and OS were 6.8 and 16.7 months compared to 5.8 and 25.7 months with platinum-based chemotherapy, showing no significant differences in PFS (p = 0.46) and OS (p = 0.85). In liver metastases, ABCP yielded a median PFS of 9.9 versus 6.1 months and an ORR of 62.5 % versus 35.7 % relative to platinum-based chemotherapy, without statistical significance (PFS p = 0.16; ORR p = 0.70).
Compared with platinum-based chemotherapy, ABCP did not improve effectiveness in patients with EGFR-mutated NSCLC after EGFR-TKI failure.
具有驱动基因突变的非小细胞肺癌（NSCLC），尤其是表皮生长因子受体（EGFR）或间变性淋巴瘤激酶突变型，对免疫检查点抑制剂的敏感性降低。对IMpower150研究中入组前对EGFR酪氨酸激酶抑制剂（EGFR-TKI）耐药患者的数据进行的亚组分析显示，阿特珠单抗、贝伐单抗、卡铂和紫杉醇（ABCP）方案较贝伐单抗、卡铂和紫杉醇方案可延长无进展生存期（PFS）。然而，由于该分析具有探索性且样本量较小，ABCP方案在EGFR-TKI治疗失败后的疗效仍存在争议。我们评估了ABCP方案与其他不含免疫检查点抑制剂的铂类方案相比的有效性和毒性。
回顾性分析了日本五家医院中接受铂类化疗或ABCP治疗的携带EGFR敏感突变的晚期或复发性NSCLC患者的数据。采用倾向评分匹配法比较疗效结果，包括总缓解率（ORR）、PFS和总生存期（OS）。
183例EGFR突变携带者中，33例接受了ABCP治疗，150例接受了铂类化疗。经过倾向评分匹配后，分别对32例和74例患者进行了分析。ABCP组的中位PFS和OS分别为6.8个月和16.7个月，而铂类化疗组分别为5.8个月和25.7个月，PFS（p = 0.46）和OS（p = 0.85）无显著差异。在肝转移患者中，ABCP组的中位PFS为9.9个月，而铂类化疗组为6.1个月；ABCP组的ORR为62.5%，铂类化疗组为35.7%，均无统计学意义（PFS p = 0.16；ORR p = 0.70）。
与铂类化疗相比，EGFR-TKI治疗失败后的EGFR突变型NSCLC患者采用ABCP方案并不能提高疗效。
