Wang Yanhua, Hao Yue, Xu Manyi, Hong Lue, Xu Chunwei, Song Zhengbo
The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.
Department of Clinical Trial, Zhejiang Cancer Hospital, Hangzhou, China.
J Thorac Dis. 2025 May 30;17(5):2856-2865. doi: 10.21037/jtd-2024-2047. Epub 2025 May 25.
Leptomeningeal metastasis (LM) is an infrequent and challenging site of metastasis in patients with non-small cell lung cancer (NSCLC). Currently, there is no standardized treatment protocol or consensus for managing NSCLC patients with LM. This study aims to comprehensively evaluate the efficacy and safety of targeted therapy in NSCLC patients with LM, with the goal of providing valuable data to inform treatment strategies for this challenging patient population.
All patients were diagnosed with LM by cerebrospinal fluid cytology and magnetic resonance imaging combined with typical clinical symptoms.
We included 193 NSCLC patients with LM who received targeted therapy. Of these, 60 patients also received concurrent leptomeningeal local therapy, including chemotherapy or radiotherapy, while 133 patients did not receive synchronous therapy. In the entire cohort, the median progression-free survival (mPFS) for patients receiving targeted therapy was 6.9 months, and the median overall survival (mOS) was 15.0 months. Significant differences in mPFS and mOS were observed between the synchronous and non-synchronous therapy groups (PFS: 11.4 6.5 months, P=0.02; mOS: 18.1 13.6 months, P=0.04). Multivariate analysis identified performance status (PS) score (P=0.01), number of treatment lines (P=0.003), combination with angiogenesis inhibitors (P=0.001), and receipt of local leptomeningeal therapy (P=0.006) as independent factors influencing PFS.
Targeted therapies have demonstrated promising results in LM patients from advanced NSCLC, particularly in those receiving concurrent local leptomeningeal therapy.
软脑膜转移（LM）是非小细胞肺癌（NSCLC）患者中一种罕见且具有挑战性的转移部位。目前，对于NSCLC合并LM患者的管理，尚无标准化的治疗方案或共识。本研究旨在全面评估靶向治疗在NSCLC合并LM患者中的疗效和安全性，目的是提供有价值的数据，为这一具有挑战性的患者群体的治疗策略提供参考。
所有患者均通过脑脊液细胞学检查、磁共振成像结合典型临床症状诊断为LM。
我们纳入了193例接受靶向治疗的NSCLC合并LM患者。其中，60例患者同时接受了软脑膜局部治疗，包括化疗或放疗，而133例患者未接受同步治疗。在整个队列中，接受靶向治疗的患者的中位无进展生存期（mPFS）为6.9个月，中位总生存期（mOS）为15.0个月。同步治疗组和非同步治疗组之间的mPFS和mOS存在显著差异（PFS：11.4对6.5个月，P = 0.02；mOS：18.1对13.6个月，P = 0.04）。多因素分析确定体能状态（PS）评分（P = 0.01）、治疗线数（P = 0.003）、联合使用血管生成抑制剂（P = 0.001）以及接受软脑膜局部治疗（P = 0.006）是影响PFS的独立因素。
靶向治疗在晚期NSCLC的LM患者中显示出有前景的结果，特别是在那些同时接受软脑膜局部治疗的患者中。
