EGFR-TKIs治疗老年非小细胞肺癌的生存获益及失败情况分析  

Survival benefit and failure patterns of EGFR-TKIs in elderly patients with advanced non-small cell lung cancer

作　　者：陈华军[1,2] 杨衿记[1,2] 严红虹[1,2] 王震[1,2] 汪斌超[1,2] 黄逸生[1,2] 吴一龙[1,2] 

机构地区：[1]广东省人民医院肿瘤中心肺部肿瘤专科 [2]广东省医学科学院,广东省肺癌研究所,广州510080

出　　处：《第三军医大学学报》2012年第20期2047-2050,共4页Journal of Third Military Medical University

摘　　要：目的探讨表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitors,EGFR-TKIs)治疗老年非小细胞肺癌(non-small cell lung cancer,NSCLC)的生存获益及失败情况。方法回顾性分析71例≥65岁的NSCLC患者,接受吉非替尼或厄洛替尼治疗后出现失败。直接测序法检测肿瘤组织的EGFR基因突变。分析不同亚组的生存获益及病灶进展部位。结果全组mPFS为10.0个月;mOS为18.0个月,EGFR基因活化突变组、野生型及状态未知的mOS组间差异没有统计学意义(P=0.200)。EGFR-TKIs一线治疗与二线或以上治疗的mOS没有统计学差异(18.0个月vs 17.8个月,P=0.631)。失败情况包括3种:26.8%为原有病灶进展,42.2%仅出现新病灶导致进展,31.0%为原有病灶进展合并新发病灶。失败情况与EGFR基因状态无相关(r=-0.05,P=0.648)。25.4%患者的进展局限于颅外,仅有8.5%患者进展局限于颅内,其中颅内新发病灶导致进展的有4例;颅内原有病灶导致进展的有2例,占有脑转移病例的11.1%。结论 EGFR-TKIs治疗中国老年NSCLC可以带来较佳的生存获益;治疗失败后多数合并新发病灶,只有少数病灶进展局限于颅内。Objective To investigate the survival benefit and failure patterns of epidermal growth factor receptor tyrosine kinase inhibitors （EGFR-TKIs） in elderly patients with advanced non-small cell lung cancer （NSCLC）. Methods A total of 71 NSCLC patients with age ≥65 with acquired resistance to gefitinib or erlotinib in our hospital during June 2002 to August 2011 were enrolled in this study. EGFR gene mutation in tumor tissue was tested by direct sequencing. Survival benefit and failure sites were analyzed. Results Medi- an progression-free survival （mPFS）and median overall survival （mOS）in the cohort were 10.0 months and 18.0 months respectively, mOSs in patients with EGFR activating mutations, wild-type or unknown status were 18.0, 21.6 and 14.3 months, respectively （P = 0. 200）. EGFR-TKIs in the first-line setting or other settings could produce comparable mOSs （ 18.0 vs 17.8 months, P =0. 631）. Failure included 3 patterns： 26.8% with pre-existing lesions progression, 42.2% with occurrence of new lesions, and 31.0% with both. Failure patterns were not correlated with EGFR mutational status （r = - 0. 05, P = 0. 648 ）. Patients of 25.4% were with extracranial progression, and 8.5 % with intracranial progression. Only cranial failure was found in 11.1% of patients with baseline brain metastasis. Conclusion EGFR-TKIs produced rational survival benefit in Chinese elderly NSCLC. New lesions tend to occur on treatment failure, and progressive lesions limited in brain are seldom observed.

关 键 词：表皮生长因子受体 酪氨酸激酶抑制剂 老年非小细胞肺癌 

分 类 号：R181.32[医药卫生—流行病学] R734.2[医药卫生—公共卫生与预防医学]