ALK阳性非小细胞肺癌脑转移患者的治疗  

Treatment of Patients with ALK-positive Non-small Cell Lung Cancer and Brain Metastases

作　　者：吕嘉林[1] 张权[1] 秦娜[1] 杨新杰[1] 张新勇[1] 吴羽华[1] 李曦[1] 张卉[1] 王敬慧[1] 张树才[1] 

机构地区：[1]首都医科大学附属北京胸科医院肿瘤内科,北京市结核病胸部肿瘤研究所,北京101149

出　　处：《结核病与胸部肿瘤》2016年第4期250-255,共6页Tuberculosis and Thoracic Tumor

摘　　要：背景与目的间变性淋巴瘤激酶（anaplasticlymphomakinase，ALK）阳性非小细胞肺癌（non—smallcelllungcancer,NSCLC）是肺癌的一个重要亚型。ALK阳性NSCLC脑转移患者的治疗尚无标准模式。方法本研究对我院2013年3月-2016年3月期间确诊的ALK阳性NSCLC脑转移患者的临床资料和治疗情况进行回顾性分析，探讨不同治疗模式患者的转归。结果84例晚期ALK阳性NSCLC患者中，22例初诊时有脑转移，剔除3例合并表皮生长因子受体（epidermalgrowthfactorreceptor,EGFR）双突变患者，共19例纳入分析。中位颅内疾病进展时间（progression．freesurvival，PFS）为12．0个月，一线脑部局部治疗（P=0．021）及一线克唑替尼治疗（P=-0．030）可延长PFS；一线克唑替尼联合脑部局部治疗的中位颅内PFS为27．0个月，而单纯克唑替尼治疗的PFS仅为4.2个月。结论一线克唑替尼联合脑部局部治疗有助于延长ALK阳性晚期NSCLC患者的颅内PFS，因例数少，尚有待大样本多中心前瞻性临床研究证实。Background and objective Anaplastic lymphoma kinase （ALK）-positive non-small cell lung cancer （NSCLC） is an important subtype of lung cancer. The standard modality ofALK-positive NSCLC with brain metastases remains uncertain. Methods We collected data on clinical characteristics and treatment of patients with ALK-positive NSCLC and brain metastases between March 2013 and March 2016 and retrospectively analyzed patient outcomes. Results In 84 ALK-positive patients with advanced NSCLC, 22 （26.2%） had brain metastases during the initial diagnosis of lung cancer, among which 3 patients with EGFR mutation were excluded, and 19 patients were analyzed. Median intracranial progression-free survival （PFS） was 12.0 months. PFS for patients who received first-line local brain therapy （P=0.021） and crizotinib therapy （P=-0.030） was superior to PFS for patients without such therapies. PFS for patients who received first-line crizotinib combined with local brain therapy was 27.0 months and only 4.2 months for those who received crizotinib alone. Conclusion First-line crizotinib therapy combined with local brain treatment can improve intracranial PFS for ALK-positive NSCLC with brain metastases. This finding should be confirmed further through multicenter, prospective clinical trials with large sample size.

关 键 词：肺肿瘤 ALK 脑转移 

分 类 号：R734.205[医药卫生—肿瘤]