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.
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。