|本期目录/Table of Contents|

一代EGFR-TKI联合同步放疗治疗EGFR-TKI耐药晚期肺腺癌患者的有效性和安全性

《现代肿瘤医学》[ISSN:1672-4992/CN:61-1415/R]

期数:
2019年20期
页码:
3616-3620
栏目:
论着(胸部肿瘤)
出版日期:
2019-09-08

文章信息/Info

Title:
Efficacy and safety of continuous EGFR-TKIs administration combined with concurrent radiotherapy in local progressed advanced lung adenocarcinoma patients previously treated with the first EGFR-TKIs
作者:
范向辉1;?王红旗2;?梁永君3
1.平顶山市第二人民医院肿瘤放疗科,河南 平顶山 467000;2.中国平煤神马集团总医院放疗科,河南 平顶山 467099;3.平顶山市第一人民医院肿瘤科,河南 平顶山 467000
Author(s):
Fan Xianghui1;?Wang Hongqi2;?Liang Yongjun3
1.Department of Radiation Oncology,Pingdingshan the Second People's Hospital,Henan Pingdingshan 467000,China;2.Department of Radiation Oncology,General Hospital of China Pingmei Shenma Group,Henan Pingdingshan 467099,China;3.Department of Oncology,Pingdingshan First People's Hospital,Henan Pingdingshan 467000,China.
关键词:
晚期肺腺癌;?表皮生长因子受体;?酪氨酸激酶抑制剂;?局部进展;?放疗
Keywords:
advanced lung adenocarcinoma;?EGFR;?tyrosine kinase inhibitor;?local progression;?radiotherapy
分类号:
R734.2
DOI:
10.3969/j.issn.1672-4992.2019.20.015
文献标识码:
A
qq自动领红包软件:
目的:探索第一代EGFR酪氨酸激酶抑制剂(EGFR-TKI)耐药后继续口服EGFR-TKI并联合局部放疗治疗晚期肺腺癌的有效性和安全性。方法:回顾性纳入2014年1月至2017年7月期间本中心符合纳入标准的、接受第一代EGFR-TKI联合局部放疗治疗的晚期肺腺癌患者,分析其疗效及不良事件发生情况。结果:研究纳入了64例符合纳入标准及排除标准的患者,继续口服原EGFR-TKIs并联合局部放疗的平均PFS为(5.48±3.85)个月。PFS与患者进展病灶不同数量相关,出现1、2、3个病灶进展患者的无进展生存期分别为6.60个月、5.17个月和 2.82个月,组间比较有显着统计学差异(P=0.006)。继续口服原EGFR-TKIs并联合局部放疗总体3-4级不良事件发生率为10.9%。结论:第一代EGFR-TKI联合局部放疗是EGFR-TKI治疗晚期肺腺癌后局部进展的有效治疗方式之一。
Abstract:
Objective:To investigate the effectiveness and safety of continuous EGFR-TKIs administration combined with concurrent radiotherapy after local progression in advanced lung adenocarcinoma patients previously treated with the first EGFR-TKIs.Methods:EGFR-mutant advanced NSCLC patients in accord with the inclusion criteria who were treated with previous EGFR-TKIs and assessed as local progression were retrospectively included from January 2014 to July 2017.Efficacy and safety information were recorded and analyzed.Results:64 patients in accord with the inclusion criteria and the exclusion criteria were included.Continuous EGFR-TKIs administration combined with concurrent radiotherapy could got a progression-free survival (PFS) of 5.48 months.PFS was significantly associated with the number of progressed lesions (median PFS:1 vs 2 vs 3 progressed lesions=6.60 vs 5.17 vs 2.82 months).There was a statistically significant difference between the groups (P=0.006).The overall 3-4 grade adverse event of this treatment was 10.9%.Conclusion:Continuous EGFR-TKIs administration combined with concurrent radiotherapy after local progression is a efficient treatment in advanced non-small cell lung cancer patients previously treated with the first EGFR-TKIs.

参考文献/References

[1] Kris MG,Gaspar LE,Chaft JE,et al.Adjuvant systemic therapy and adjuvant radiation therapy for stage I to IIIa completely resected non-small-cell lung cancers:American Society of Clinical Oncology/Cancer Care Ontario Clinical Practice Guideline Update[J].Journal of Clinical Oncology,2017,35(25):JCO2017724401.
[2]Offin M,Rizvi H,Tenet M,et al.Tumor mutation burden and efficacy of EGFR-tyrosine kinase inhibitors in patients with EGFR-mutant lung cancers[J].Clin Cancer Res,2018,7(25):1-16.
[3] Califano R,Romanidou O,Mountzios G,et al.Management of NSCLC disease progression after first-line EGFR tyrosine kinase inhibitors:What are the issues and potential therapies[J]?Drugs,2016,76(8):831-840.
[4] Sun ML,Syn NL,Cho BC,et al.Acquired resistance to EGFR targeted therapy in non-small cell lung cancer:Mechanisms and therapeutic strategies[J].Cancer Treatment Reviews,2018,4(65):1-10.
[5] Corte CMD,Malapelle U,Vigliar E,et al.Efficacy of continuous EGFR-inhibition and role of Hedgehog in EGFR acquired resistance in human lung cancer cells with activating mutation of EGFR[J].Oncotarget,2017,8(14):23020-23032.
[6] Peng L,Wang Y,Tang Y,et al.Continuous EGFR tyrosine kinase inhibitor treatment with or without chemotherapy beyond gradual progression in non-small cell lung cancer patients[J].Onco Targets Ther,2017(10):4261-4267.
[7] LI Jianying,WU Xiaomin,HE Linghui,et al.Therapeutic effect of EGFR-TKI combined with chemotherapy in the treatment of advanced non-small cell lung cancer with EGFR-TKI acquired resistance[J].Chinese Journal of Cancer,2013,23(6):462-466.[李剑英,吴晓敏,何灵慧,等.EGFR-TKI联合化疗治疗EGFR-TKI获得性耐药的晚期非小细胞肺癌疗效分析[J].中国癌症杂志,2013,23(6):462-466.]
[8] Wang Y,Li Y,Xia L,et al.Continued EGFR-TKI with concurrent radiotherapy to improve time to progression (TTP) in patients with locally progressive non-small cell lung cancer (NSCLC) after front-line EGFR-TKI treatment[J].Clinical & Translational Oncology,2018,20(3):366-373.
[9]Jiang T.Addition of bevacizumab for malignant pleural effusion as the manifestation of acquired EGFR-TKI resistance in NSCLC patients[J].Oncotarget,2017,8(37):62648-62657.
[10] Jnne PA,Yang JC,Kim DW,et al.AZD9291 in EGFR inhibitor-resistant non-small-cell lung cancer[J].New England Journal of Medicine,2015,372(18):1689.
[11] PI Can,ZHANG Yichen,XU Chongrui,et al.Accurate treatment of epidermal growth factor receptor-sensitive mutation-positive non-small cell lung cancer[J].Chinese Journal of Oncology,2017,39(2):94-97.[皮灿,张一辰,徐崇锐,等.表皮生长因子受体敏感突变阳性非小细胞肺癌耐药后的精准治疗[J].中华肿瘤杂志,2017,39(2):94-97.]
[12] Yang JJ,Chen HJ,Yan HH,et al.Clinical modes of EGFR tyrosine kinase inhibitor failure and subsequent management in advanced non-small cell lung cancer[J].Lung Cancer,2013,79(1):33-39.
[13]Inomata M,Shukuya T,Takahashi T,et al.Continuous administration of EGFR-TKIs following radiotherapy after disease progression in bone lesions for non-small cell lung cancer[J].Anticancer Research,2011,31(12):4519-4523.
[14] Shukuya T,Takahashi T,Naito T,et al.Continuous EGFR-TKI administration following radiotherapy for non-small cell lung cancer patients with isolated CNS failure[J].Lung Cancer,2011,74(3):457-461.
[15] Huang J.Local therapy with continued EGFR tyrosine kinase inhibitor therapy as a treatment strategy in EGFR-mutant advanced lung cancers that have developed acquired resistance to EGFR tyrosine kinase inhibitors[J].Journal of Thoracic Oncology,2013,8(3):346-351.
[16] Xu Q,Zhou F,Liu H,et al.Consolidative local ablative therapy improves the survival of patients with synchronous oligometastatic NSCLC harboring EGFR activating mutation treated with first-line EGFR-TKIs[J].Journal of Thoracic Oncology,2018,13(9):1383-1392.
[17]Hong SH,Kim YS,Ji EL,et al.Clinical characteristics and continued epidermal growth factor receptor tyrosine kinase inhibitor administration in EGFR-mutated non-small cell lung cancer with skeletal metastasis[J].Cancer Research & Treatment,2016,48(3):1110-1119.
[18] CHEN Wenju,WU Shusheng,HE Yifu,et al.Mechanism and effect of intercalated therapy with chemotherapy and EGFR-TKIs for advanced NSCLC patients[J].Modern Oncology,2017,25(11):1844-1848.[陈文菊,吴书胜,何义富,等.化疗序贯EGFR-TKIs治疗晚期非小细胞肺癌的机制及疗效[J].现代肿瘤医学,2017,25(11):1844-1848.]
[19] Ni Y,Qi H,Qing G,et al.Local microwave ablation with continued EGFR tyrosine kinase inhibitor as a treatment strategy in advanced non-small cell lung cancers that developed extra-central nervous system oligoprogressive disease during EGFR tyrosine kinase inhibitor treatment[J].Medicine,2016,95(25):e3998.
[20] Wang X,Xu Y,Tang W,et al.Efficacy and safety of radiotherapy plus EGFR-TKIs in NSCLC patients with brain metastases:A meta-analysis of published data[J].Transl Oncol,2018,11(5):1119-1127.
[21]Zhang Q,Ke E,Niu F,et al.The role of T790M mutation in EGFR-TKI re-challenge for patients with EGFR-mutant advanced lung adenocarcinoma[J].Oncotarget,2017,8(3):4994-5002.
[22] Lee DH.Treatments for EGFR-mutant non-small cell lung cancer (NSCLC):The road to a success,paved with failures[J].Pharmacology & Therapeutics,2017,6(174):1-21.

备注/Memo

备注/Memo:
-
更新日期/Last Update: 1900-01-01