Continuous Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Treatment May Not Hinder the Survival of Patients with Primary Lung Adenocarcinoma despite Indolent New Lesions

肺腺癌病人產生新病灶時，持續使用Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors可能不會影響整體存活期

邱立忠(Li-Chung Chiu) ； 黃澤宏(Tse-Hung Huang) ； 高國晉(Kuo-Chin Kao) ； 李忠恕(Chung-Shu Lee) ； 黃崇旂(Chung-Chi Huang) ； 余志騰(Chih-Teng Yu) ； 陳濘宏(Ning-Hung Chen) ； 楊政達(Cheng-Ta Yang) ； 蔡熒煌(Ying-Huang Tsai) ； 劉劍英(Chien-Ying Liu)

《胸腔醫學》 28卷2期 (2013/04) Pp. 73-88

摘要

背景：使用Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors（EGFR-TKI）治療肺腺癌病人最終會因為抗藥性而使疾病惡化。然而，因為只有少數文獻探討當產生新病灶時，持續使用EGFR-TKI對存活時間之益處，本研究回顧性分析對於Response Evaluation Criteria in Solid Tumors（RECIST）定義之疾病惡化狀況下可能的治療效果。方法：本研究從2005年1月至2009年11月前瞻性記錄，回顧性分析37位肺腺癌病人。所有病人對於EGFR-TKI都至少有6個月之無惡化存活期，且原發部位肺腫瘤變小或穩定，而後產生新病灶。26位病人持續使用而11位病人停止使用EGFR-TKI。我們比較此二組病人之整體存活期，停止使用EGFRTKI後之存活期和出現新病灶後之存活期。結果：停止使用EGFR-TKI組整體存活期中位數為480天，繼續使用EGFR-TKI組整體存活期中位數為771.5天（p=0.1838）。停止使用EGFR-TKI後，存活期中位數在停止使用組為117.0天，在繼續使用組為143.0天（p=0.9106），而出現新病灶後之存活期中位數在停止使用組為152.0天，在繼續使用組為262.0天（p=0.0571）。結論：肺腺瘤病人在EGFR-TKI治療下初始有反應，當出現新病灶時，繼續使用EGFR-TKI可能不會影響存活期。

關鍵字

epidermal growth factor receptor tyrosine kinase inhibitors ； 新病灶 ； 病情惡化 ； 整體存活期 ； 無惡化存活期

並列摘要

Background: Lung adenocarcinoma treated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) eventually develops progressive disease (PD) due to acquired resistance. However, since there are few published reports on the survival benefit of continuous EGFR-TKI administration for indolent new lesions, the present study retrospectively analyzed the possible treatment effect on PD status as defined by the Response Evaluation Criteria in Solid Tumors (RECIST). Methods: From January 2005 to November 2009, the data of 37 lung adenocarcinoma patients were prospectively recorded and retrospectively analyzed and evaluated. All patients had at least 6 months of progression-free survival (PFS) with EGFR-TKI and definite new lesions during EGFR-TKI therapy, with the primary targeted lung lesions remaining regressive or stable. Twenty-six patients continued and 11 discontinued EGFR-TKI therapy. Overall survival (OS), survival after discontinuation of EGFR-TKI, and survival after the appearance of definite new lesions were compared. Results: The median OS was 480 days for the discontinuation group and 771.5 days for the continuation group (p=0.1838). Median survival time after discontinuation of EGFRTKI was 117.0 days and 143.0 days in the 2 groups, respectively (p=0.9106), while median survival time after the appearance of indolent new lesions was 152.0 days and 262.0 days, respectively (p=0.0571). Conclusion: Continuous EGFR-TKI administration in patients with primary lung adenocarcinoma with an initial response and the appearance of new indolent lesions may not hinder the survival benefit.

並列關鍵字

epidermal growth factor receptor tyrosine kinase inhibitors ； new lesions ； progressive disease ； overall survival ； progression-free survival