一代表皮生长因子受体酪氨酸激酶抑制剂一线治疗晚期非小细胞肺癌患者166例无进展生存期分析
|
摘要
目的探讨一代表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKI)一线治疗晚期非小细胞肺癌(NSCLC)EGFR基因敏感突变患者的无进展生存(PFS)时间获益分析。方法随访2016—2017年中南大学湘雅医院一代EGFR-TKI一线治疗的166例非小细胞肺癌患者,根据PFS将患者分为PFS≤3个月组、>3～<12个月组、≥12个月组,分析PFS的获益因素。结果一代EGFR-TKI为影响PFS的独立因素(P<0.05),其中厄洛替尼进展的风险是埃克替尼的2.16倍,吉非替尼进展的风险是埃克替尼的4.48倍。PFS≤3个月和PFS≥12个月两组的Logistic回归分析显示,埃克替尼组疗效最佳(埃克替尼对吉非替尼,P=0.009;埃克替尼对厄洛替尼,P=0.006),EGFR 19号外显子del (19del)突变组优于EGFR 21号外显子L858R点突变组(21L858R)(P=0.024),腺癌组优于非腺癌组(P=0.044),中分化组优于低分化组(P=0.022)。多因素分析显示,埃克替尼组疗效优于厄洛替尼和吉非替尼组(P分别为0.018和0.006),腺癌组优于非腺癌(P=0.015),中分化组优于低分化组(P=0.034)。结论组织学类型、分化程度、EGFR基因等基线状态的不同可致不同PFS,一代EGFR-TKI药物为影响PFS的独立因素。
Objective Explore the clinical benefit factors of progression-free survival(PFS) in sensitive epithelial growth factor receptor(EGFR) gene mutated advanced non-small cell lung cancer patients treated with first-generation of EGFR tyrosine kinase inhibitor(TKI).Methods The clinical data of 166 patients who received first-line treatment with first-generation EGFR-TKI were retrospectively collected in 2016-2017 from Xiangya Hospital, Central South University. The patients were divided into three groups: PFS≤3 m,3 m
Objective Explore the clinical benefit factors of progression-free survival(PFS) in sensitive epithelial growth factor receptor(EGFR) gene mutated advanced non-small cell lung cancer patients treated with first-generation of EGFR tyrosine kinase inhibitor(TKI).Methods The clinical data of 166 patients who received first-line treatment with first-generation EGFR-TKI were retrospectively collected in 2016-2017 from Xiangya Hospital, Central South University. The patients were divided into three groups: PFS≤3 m,3 m
引文
[1]Bouzbid S,Hamdi-Chérif M,Zaidi Z,et al.Global surveillance of trends in cancer survival 2000-14(CONCORD-3):analysis of individual records for 37 513 025 patients diagnosed with one of18 cancers from 322 population-based registries in 71 countries[J]Lancet,2018,391(10125):1023-1075.
[2]Maemondo M,Inoue A,Kobayashi K,et al.Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR[J].N Engl J Med2010,362(25):2380-2388.
[3]Zhou C,Wu YL,Chen G,et al.Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutationpositive non-small-cell lung cancer(OPTIMAL,CTONG-0802):a multicentre,open-label,randomised,phase 3 study[J].Lancet Oncol2011,12(8):735-742.
[4]Shi YK,Wang L,Han BH,et al.First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma(CONVINCE):a phase 3,open-label,randomized study[J].Ann Oncol,2017,28(10):2443-2450.
[5]Wheeler DL,Dunn EF,Harari PM.Understanding resistance to EGFRinhibitors-impact on future treatment strategies[J].Nat Rev Clin Oncol,2010,7(9):493-507.
[6]Takeda M,Okamoto I,Fujita Y,et al.De novo resistance to epidermal growth factor receptor-tyrosine kinase inhibitors in EGFR mutationpositive patients with non-small cell lung cancer[J].J Thorac Oncol2010,5(3):399-400.
[7]Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J]Eur J Cancer,2009,45:228-247
[8]Mok TS,Wu YL,Thongprasert S,et al.Gefitinib or carboplatinpaclitaxel in pulmonary adenocarcinoma[J].N Engl J Med,2009,361(10):947-957.
[9]Yang JJ,Zhou Q,Yan HH,et al.A phase III randomised controlled trial of erlotinib vs gefitinib in advanced non-small cell lung cancer with EGFR mutations[J].Br J Cancer,2017,116(5):568-574.
[10]Jiang X,Wang W,Zhang Y.Clinical Analysis of Icotinib on Beneficiary of Advanced Non-small Cell Lung Cancer with EGFR Common Mutation[J].Zhongguo Fei Ai Za Zhi,2016,19(4):200-206.
[11]Liu D,Jiang J,Zhang L,et al.Metabolite characterization of a novel anti-cancer agent,icotinib,in humans through liquid chromatography/quadrupole time-of-flight tandem mass spectrometry[J].Rapid Commun Mass Spectrom,2011 Aug,25(15):2131-2140.
[12]Shukuya T,Takahashi T,Kaira R,et al.Efficacy of gefitinib for nonadenocarcinoma non-small-cell lung cancer patients harboring epidermal growth factor receptor mutations:a pooled analysis of published reports[J].Cancer Sci,2011,102(5):1032-1037.
[13]Sequist LV,Heist RS,Shaw AT,et al.Implementing multiplexed genotyping of non-small-cell lung cancers into routine clinical practice[J].Ann Oncol,2011,22(12):2616-2624.
[14]冯佳,许斌,宋启斌.EGFR19与21号外显子突变的晚期非小细胞肺癌一线TKI治疗疗效差异的研究进展[J].肿瘤学杂志2016,22(3):167-171.
[15]Zhou Q,Zhang XC,Chen ZH,et al.Relative abundance of EGFRmutations predicts benefit from gefitinib treatment for advanced nonsmall-cell lung cancer[J].J Clin Oncol,2011,29(24):3316-3321.
[2]Maemondo M,Inoue A,Kobayashi K,et al.Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR[J].N Engl J Med2010,362(25):2380-2388.
[3]Zhou C,Wu YL,Chen G,et al.Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutationpositive non-small-cell lung cancer(OPTIMAL,CTONG-0802):a multicentre,open-label,randomised,phase 3 study[J].Lancet Oncol2011,12(8):735-742.
[4]Shi YK,Wang L,Han BH,et al.First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma(CONVINCE):a phase 3,open-label,randomized study[J].Ann Oncol,2017,28(10):2443-2450.
[5]Wheeler DL,Dunn EF,Harari PM.Understanding resistance to EGFRinhibitors-impact on future treatment strategies[J].Nat Rev Clin Oncol,2010,7(9):493-507.
[6]Takeda M,Okamoto I,Fujita Y,et al.De novo resistance to epidermal growth factor receptor-tyrosine kinase inhibitors in EGFR mutationpositive patients with non-small cell lung cancer[J].J Thorac Oncol2010,5(3):399-400.
[7]Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J]Eur J Cancer,2009,45:228-247
[8]Mok TS,Wu YL,Thongprasert S,et al.Gefitinib or carboplatinpaclitaxel in pulmonary adenocarcinoma[J].N Engl J Med,2009,361(10):947-957.
[9]Yang JJ,Zhou Q,Yan HH,et al.A phase III randomised controlled trial of erlotinib vs gefitinib in advanced non-small cell lung cancer with EGFR mutations[J].Br J Cancer,2017,116(5):568-574.
[10]Jiang X,Wang W,Zhang Y.Clinical Analysis of Icotinib on Beneficiary of Advanced Non-small Cell Lung Cancer with EGFR Common Mutation[J].Zhongguo Fei Ai Za Zhi,2016,19(4):200-206.
[11]Liu D,Jiang J,Zhang L,et al.Metabolite characterization of a novel anti-cancer agent,icotinib,in humans through liquid chromatography/quadrupole time-of-flight tandem mass spectrometry[J].Rapid Commun Mass Spectrom,2011 Aug,25(15):2131-2140.
[12]Shukuya T,Takahashi T,Kaira R,et al.Efficacy of gefitinib for nonadenocarcinoma non-small-cell lung cancer patients harboring epidermal growth factor receptor mutations:a pooled analysis of published reports[J].Cancer Sci,2011,102(5):1032-1037.
[13]Sequist LV,Heist RS,Shaw AT,et al.Implementing multiplexed genotyping of non-small-cell lung cancers into routine clinical practice[J].Ann Oncol,2011,22(12):2616-2624.
[14]冯佳,许斌,宋启斌.EGFR19与21号外显子突变的晚期非小细胞肺癌一线TKI治疗疗效差异的研究进展[J].肿瘤学杂志2016,22(3):167-171.
[15]Zhou Q,Zhang XC,Chen ZH,et al.Relative abundance of EGFRmutations predicts benefit from gefitinib treatment for advanced nonsmall-cell lung cancer[J].J Clin Oncol,2011,29(24):3316-3321.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |