Abstract：
BACKGROUND: EGFR tyrosine kinase inhibitors (TKIs) are the standard therapy for non-small-cell lung cancer (NSCLC) patients with EGFR-activating mutations in the first-line setting. Despite initial efficacy, resistance to EGFR-TKIs often develops, and platinum-based chemotherapy is the predominant subsequent treatment. For this study, we aimed to identify prognostic factors for overall survival (OS) and progression-free survival (PFS) among advanced EGFR-mutant NSCLC patients receiving platinum-pemetrexed after progression on EGFR-TKIs. Our analysis specifically focuses on 1st-line treatments limited to 1st- or 2nd-generation EGFR-TKIs, while not restricting later-line treatments involving osimertinib prior to chemotherapy.
METHODS: From 2012 to 2017, 363 patients who received first-line treatment with first- or second-generation EGFR-TKIs, including gefitinib, erlotinib, and afatinib were enrolled. Some patients received different EGFR-TKIs, including osimertinib, as later-line treatment before platinum-pemetrexed.
RESULTS: Median OS from the initiation of platinum-pemetrexed was 22.0 months and median PFS with platinum-pemetrexed was 6.2 months. In the multivariate Cox model, we identified three independent prognostic factors for better OS: postoperative recurrence (HR: 0.34, p = 0.004), first-line EGFR-TKI PFS ≥12 months (HR: 0.54, p = 0.002), and osimertinib treatment after platinum-pemetrexed (HR: 0.56, p = 0.005) while BMI <18.5 indicated poor prognosis (HR:1.76, p = 0.049). No statistically significant independent prognostic factors for PFS were found. Receiving osimertinib before platinum-pemetrexed treatment did not impact PFS with platinum-pemetrexed treatment (HR: 1.11, p = 0.64).
CONCLUSIONS: Postoperative recurrence, first-line EGFR-TKI PFS ≥12 months and osimertinib treatment after platinum-pemetrexed predicted better OS, while BMI <18.5 predicted worse OS. Osimertinib treatment before platinum-pemetrexed treatment did not affect the efficacy of platinum-pemetrexed.
METHODS: From 2012 to 2017, 363 patients who received first-line treatment with first- or second-generation EGFR-TKIs, including gefitinib, erlotinib, and afatinib were enrolled. Some patients received different EGFR-TKIs, including osimertinib, as later-line treatment before platinum-pemetrexed.
RESULTS: Median OS from the initiation of platinum-pemetrexed was 22.0 months and median PFS with platinum-pemetrexed was 6.2 months. In the multivariate Cox model, we identified three independent prognostic factors for better OS: postoperative recurrence (HR: 0.34, p = 0.004), first-line EGFR-TKI PFS ≥12 months (HR: 0.54, p = 0.002), and osimertinib treatment after platinum-pemetrexed (HR: 0.56, p = 0.005) while BMI <18.5 indicated poor prognosis (HR:1.76, p = 0.049). No statistically significant independent prognostic factors for PFS were found. Receiving osimertinib before platinum-pemetrexed treatment did not impact PFS with platinum-pemetrexed treatment (HR: 1.11, p = 0.64).
CONCLUSIONS: Postoperative recurrence, first-line EGFR-TKI PFS ≥12 months and osimertinib treatment after platinum-pemetrexed predicted better OS, while BMI <18.5 predicted worse OS. Osimertinib treatment before platinum-pemetrexed treatment did not affect the efficacy of platinum-pemetrexed.
摘要：
背景：EGFR酪氨酸激酶抑制剂（TKIs）是一线治疗EGFR激活突变的非小细胞肺癌（NSCLC）患者的标准疗法。尽管最初的疗效，对EGFR-TKIs的耐药性经常发展，以铂类为基础的化疗是主要的后续治疗。对于这项研究，我们旨在确定EGFR-TKIs进展后接受铂-培美曲塞治疗的晚期EGFR突变型NSCLC患者的总生存期(OS)和无进展生存期(PFS)的预后因素.我们的分析特别关注限于第一代或第二代EGFR-TKIs的一线治疗，同时不限制化疗前涉及奥希替尼的后期治疗。
方法：2012年至2017年，363例接受第一代或第二代EGFR-TKIs一线治疗的患者，包括吉非替尼,厄洛替尼,和阿法替尼被纳入.一些患者接受了不同的EGFR-TKIs，包括奥希替尼,作为铂-培美曲塞之前的后期治疗。
结果：从铂-培美曲塞开始的中位OS为22.0个月，铂-培美曲塞的中位PFS为6.2个月。在多元Cox模型中，我们确定了改善OS的三个独立预后因素：术后复发（HR：0.34，p=0.004），一线EGFR-TKIPFS≥12个月（HR：0.54，p=0.002），和奥希替尼治疗后铂-培美曲塞（HR：0.56，p=0.005），而BMI<18.5表明预后不良（HR：1.76，p=0.049）。未发现有统计学意义的PFS独立预后因素。在铂-培美曲塞治疗之前接受奥希替尼并不影响铂-培美曲塞治疗的PFS(HR:1.11,p=0.64)。
结论：术后复发，铂-培美曲塞一线EGFR-TKIPFS≥12个月和奥希替尼治疗可预测更好的OS,而BMI<18.5则预测OS恶化。铂-培美曲塞治疗前的奥希替尼治疗不影响铂-培美曲塞的疗效。
方法：2012年至2017年，363例接受第一代或第二代EGFR-TKIs一线治疗的患者，包括吉非替尼,厄洛替尼,和阿法替尼被纳入.一些患者接受了不同的EGFR-TKIs，包括奥希替尼,作为铂-培美曲塞之前的后期治疗。
结果：从铂-培美曲塞开始的中位OS为22.0个月，铂-培美曲塞的中位PFS为6.2个月。在多元Cox模型中，我们确定了改善OS的三个独立预后因素：术后复发（HR：0.34，p=0.004），一线EGFR-TKIPFS≥12个月（HR：0.54，p=0.002），和奥希替尼治疗后铂-培美曲塞（HR：0.56，p=0.005），而BMI<18.5表明预后不良（HR：1.76，p=0.049）。未发现有统计学意义的PFS独立预后因素。在铂-培美曲塞治疗之前接受奥希替尼并不影响铂-培美曲塞治疗的PFS(HR:1.11,p=0.64)。
结论：术后复发，铂-培美曲塞一线EGFR-TKIPFS≥12个月和奥希替尼治疗可预测更好的OS,而BMI<18.5则预测OS恶化。铂-培美曲塞治疗前的奥希替尼治疗不影响铂-培美曲塞的疗效。
