背景:表皮生长因子受体(EGFR)突变的非小细胞肺癌(NSCLC)对酪氨酸激酶抑制剂(TKIs)产生耐药性。这里,我们评估了EGFR-TKIs后少进展的晚期NSCLC患者放疗和继续TKIs的疗效.
方法:2011年1月至2019年1月,33例EGFR突变型非小细胞肺癌TKIs患者接受放疗并延续TKIs治疗。主要终点是中位无进展生存期1(mPFS1),mPFS2和中位总生存期(mOS)。从EGFR-TKIs治疗开始到疾病的少进展测量PFS1。从少进展到疾病进一步进展的日期测量PFS2,而OS是从少进展到任何原因死亡计算的,或者在最后一次随访日期进行审查。
结果:mPFS1,mPFS2和mOS为11.0(95%CI,4.4-17.6),6.5(95%CI,1.4-11.6)和21.8(95%CI,14.8-28.8)个月,分别。单因素分析显示EGFR突变类型(p=0.024),放射治疗方法(p=0.001),和性能状态(p=0.017)与PFS2显著相关。单因素分析显示,性别(p=0.038),吸烟史(p=0.031),EGFR突变类型(p=0.012),放疗方式(p=0.009)与OS显著相关。多因素分析显示放疗方式(p=0.001)和表现状态(p=0.048)是PFS2的预后因素,放疗方式(p=0.040)是OS的预后因素。
结论:持续TKIs的放疗对EGFR突变的少进展NSCLC有效,应该尽快进行。T790M+患者对放疗敏感性较高,表现状态良好且接受立体定向放射治疗的患者PFS2和OS较好。
Epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) develops resistance to tyrosine kinase inhibitors (TKIs). Here, we evaluated the efficacy of radiotherapy and continuation of TKIs in patients with advanced NSCLC with
oligoprogression after EGFR-TKIs.
From January 2011 to January 2019, 33 patients with EGFR-mutated NSCLC on TKIs were treated by radiotherapy and continuation of TKIs for oligoprogressive disease. The primary endpoints were median progression-free survival 1 (mPFS1), mPFS2, and median overall survival (mOS). PFS1 was measured from the start of EGFR-TKIs therapy to the
oligoprogression of the disease. PFS2 was measured from the date of
oligoprogression to the further progression of the disease, while OS was calculated from
oligoprogression to death from any cause or was censored at the last follow-up date.
The mPFS1, mPFS2, and mOS were 11.0 (95% CI, 4.4-17.6), 6.5 (95% CI, 1.4-11.6) and 21.8 (95% CI, 14.8-28.8) months, respectively. Univariate analysis showed that EGFR mutation type (p = 0.024), radiotherapy method (p = 0.001), and performance status (p = 0.017) were significantly correlated with PFS2. Univariate analysis showed that sex (p = 0.038), smoking history (p = 0.031), EGFR mutation type (p = 0.012), and radiotherapy method (p = 0.009) were significantly correlated with OS. Multivariate analysis suggested that radiotherapy method (p = 0.001) and performance status (p = 0.048) were prognostic factors for PFS2, and radiotherapy method (p = 0.040) was a prognostic factor for OS.
Radiotherapy with continued TKIs is effective for EGFR-mutated NSCLC with
oligoprogression, and it should be conducted as soon as possible. T790M+ patients have higher sensitivity to radiotherapy, and patients with good performance status and stereotactic body radiation therapy have better PFS2 and OS.