奥西替尼治疗表皮生长因子受体突变的老年晚期肺腺癌患者回顾性分析  

A retrospective analysis of Osimertinib in treatment of elderly patients with advanced lung adenocarcinoma with epidermal growth factor receptor mutation

作　　者：武晓楠[1] 张萍[1] 聂鑫[1] 唐敏[1] 马迪 李旭[1] 李琳[1] Wu Xiaonan;Zhang Ping;Nie Xin;Tang Min;Ma Di;Li Xu;Li Lin(Department of Oncology,Beijing Hospital,National Center of Gerontology Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730 China)

机构地区：[1]北京医院肿瘤内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2023年第3期322-327,共6页Chinese Journal of Geriatrics

基　　金：科技部十三五重大疾病新药临床评价技术平台建设子课题(2017ZX09304026);中国医学科学院医学与健康科技创新工程"肺癌精准诊疗研究"(2021-I2M-1-012)。

摘　　要：目的 评估奥西替尼在表皮生长因子受体(EGFR)突变老年晚期肺腺癌人群中二线及以上治疗应用的疗效及安全性。方法 回顾性分析51例65岁及以上的老年晚期肺腺癌患者,基线检测存在EGFR基因突变,一线应用一代或二代表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)药物治疗疾病进展后,在二线或后线应用奥西替尼治疗。结果 患者中位年龄72岁。应用奥西替尼中位无进展生存期(PFS)13个月,95%CI(10.8~15.2)个月。其中EGFR19外显子缺失突变(19deletion,19del)的患者应用奥西替尼的PFS优于EGFR21外显子L858R突变患者(12和24个月,P=0.028)。在EGFR耐药突变T790M阳性(T790M+)的患者中,19del合并T790M+(19del/T790M+)的患者的PFS优于L858R合并T790M+(L858R/T790M+)的患者(10和28个月,P=0.029)。奥西替尼治疗耐药后有43.8%的患者存在脑或脑膜进展。奥西替尼耐药后治疗最常应用的药物为抗血管生成类药物。奥西替尼常见不良反应为腹泻(31.4%)、皮肤干燥伴瘙痒(29.4%)和皮疹(25.5%)。大部分不良反应为1到2级,1例患者因3级血液学不良反应间断停药。结论 老年晚期EGFR突变肺腺癌患者后线应用奥西替尼疗效确切,患者耐受性良好。Objective To evaluate the efficacy and safety of Osimertinib in the second-line and above treatment of elderly patients with advanced lung adenocarcinoma with epidermal grouth factor receptor(EGFR)mutation.Methods A retrospective analysis of 51 elderly patients with advanced lung adenocarcinoma aged 65 years and over was performed.EGFR gene mutations were detected at baseline.The patients were treated with Osimertinib as second or later-line treatment after disease progression on prior epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)therapy.Results The median age of the patients was 72 years old,and the median progression-free survival(PFS)with Osimertinib was 13 months(95%CI:10.8-15.2 months).Patients with exon 19 deletion(19del)treated with Osimertinib had longer PFS than patients with EGFR 21 exon L858R mutation(12 vs.24 month,P=0.028).In patients with EGFR resistance mutation T790M(T790M-positive),the PFS of patients with 19del combined with T790M(19del/T790M-positive)was better than that of patients with L858R combined with T790M(L858R/T790M-positive)(10 vs.28 months,P=0.029).After Osimertinib treatment,43.8%of patients had brain or meningeal progression.The most commonly used agents for treatment after resistance to Osimertinib are antiangiogenic drugs.The common adverse reactions of Osimertinib were diarrhea(31.4%),followed by dry skin with itching(29.4%)and rash(25.5%).Most adverse reactions were grade 1 to 2,and one patient discontinued the drug intermittently due to grade 3 hematological adverse reactions.Conclusions Osimertinib is effective and well tolerated in elderly patients with advanced EGFR-mutant lung adenocarcinoma.

关 键 词：肺腺癌 表皮生长因子 受体突变 奥西替尼 

分 类 号：R734.2[医药卫生—肿瘤]