背景:阿替珠单抗,贝伐单抗,卡铂,和紫杉醇(ABCP)联合治疗在酪氨酸激酶抑制剂(TKI)治疗后出现表皮生长因子受体(EGFR)突变的非鳞状非小细胞肺癌(NSCLC)患者中具有潜在疗效.然而,关于ABCP治疗作为EGFR-TKI使用的主要结局的有效性的研究缺乏.
方法:对24例IV期EGFR阳性非鳞状NSCLC患者进行了单中心回顾性分析,这些患者接受了一种或多种EGFR-TKI治疗,随后在2019年4月1日至2023年4月30日的时间范围内开始了ABCP治疗。这项研究评估了与ABCP治疗相关的总生存期和无进展生存期。进一步分析基于EGFR亚组的总生存数据.
结果:该队列的平均年龄为65±9岁,有14名女性(58%)。表现状态(PS)记录为24例患者中有13例(54%),24例患者中有11例(46%)。13例(54%)患者有吸烟史。腺癌组织学在所有病例中都很普遍。EGFR突变包括14例患者(58%)的Ex19del和10例(42%)的L858R。在ABCP治疗开始时,肝转移明显3例(13%),脑转移明显8例(33%)。程序性死亡配体1(22C3)表达水平不同,<1%,1-49%,在五个人中观察到≥50%,11和5个案例,分别,而三例病例的数据缺失。中位随访时间为14.1个月,中位总生存期估计为23.6个月(95%CI:14.5个月-未达到),中位无进展生存期估计为5.6个月(95%CI:4.9-11.5个月).与EGFREx19del突变相比,EGFRL858R突变在总生存期中显示出有利的趋势(未评估与23.6个月)。
结论:ABCP治疗EGFR阳性非鳞状细胞肺癌是一个有希望的选择,类似于无免疫检查点抑制剂的铂类联合治疗.因此,有必要进行前瞻性试验以确认这些治疗的疗效.
BACKGROUND: Atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) combination therapy has a potential efficacy in a specific subset of non-squamous non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations following tyrosine kinase inhibitor (TKI) treatment. However, there is a dearth of investigations on the effectiveness of ABCP therapy as the primary outcome of EGFR-TKI use.
METHODS: A single-center retrospective analysis was performed on 24 cases of stage IV EGFR-positive non-squamous NSCLC patients who received one or more lines of EGFR-TKI therapy and subsequently initiated ABCP therapy within the timeframe of April 1, 2019, to April 30, 2023. This study assessed overall survival and progression-free survival associated with ABCP therapy, further analyzing the overall survival data based on EGFR subgroups.
RESULTS: The mean age of the cohort was 65 ± 9 years with 14 females (58%). The performance status (PS) was recorded as 0 in 13 out of 24 patients (54%) and 1 in 11 out of 24 patients (46%). Thirteen (54%) patients had a history of smoking. Adenocarcinoma histology was prevalent in all cases. The EGFR mutations included Ex19del in 14 patients (58%) and L858R in 10 (42%) patients. At ABCP therapy initiation, liver metastases were evident in three cases (13%) and brain metastases in eight (33%). Programmed death ligand 1 (22C3) expression levels varied, with <1%, 1-49%, and ≥50% observed in five, 11, and five cases, respectively, while data were missing for three cases. The median follow-up duration was 14.1 months, with median overall survival estimated at 23.6 months (95% CI: 14.5 months - not reached) and median progression-free survival at 5.6 months (95% CI: 4.9-11.5 months). The EGFR L858R mutation showed a favorable trend in overall survival compared with the EGFR Ex19del mutation (not evaluated vs. 23.6 months).
CONCLUSIONS: ABCP therapy for EGFR-positive non-squamous NSCLC is a promising option, similar to immune checkpoint inhibitor-free platinum-based combination therapy. Therefore, prospective trials are necessary to confirm the efficacy of these treatments.