Erlotinib用於肺腺癌EGFR野生型患者化學治療後之療效探討

Efficacy of Erlotinib in Post-Chemotherapy EGFR Wild-Type Lung Adenocarcinoma Patients

劉錦鳳(Chin-Feng Liu) ； 鄭幸宜(Hsingi-I Cheng) ； 李樂業(Lo-Yeh Lee)

《臺灣臨床藥學雜誌》 26卷1期 (2018/01) Pp. 47-58

https://doi.org/10.6168/FJCP.201801_26(1).0006

摘要

目的：近來研究酪胺酸激酶抑制劑 (tyrosine kinase inhibitors)標靶藥品之一的erlotinib，用於表皮生長因子接受器(epidermal growth factor receptor, EGFR)野生型病人在治療效益上一直被探討；而臺灣多數的肺腺癌患者屬於突變型，相較之下沒有突變的族群在erlotinib療效評估的文獻較少。因此本篇研究探討臺灣某醫學中心EGFR 基因檢測為野生型的肺腺癌病人中，觀察使用erlotinib療效與副作用情形。方法：本篇以回溯方式蒐集2013年10月到2016年5月間合格病人條件：肺腺癌為第IIIB期或第IV期、曾接受手術治療又局部復發或遠端轉移，並以基因檢驗方法檢測出EGFR基因為野生型，以及開始服用erlotinib前有接受過全身性化學治療。病人每日一錠erlotinib 150 mg直到疾病出現進展或無法忍受的副作用而停止。結果：此研究共收案22位病人，年齡中位數為64歲（35~81歲）。22位病人在overall response rate和disease control rate表現上分別為27%和68.1%，progression-free survival和event-free survival之中位數存活期為5.5個月(95% confidence interval [CI]: 0.00-12.2)和6.1個月(95% CI: 0.4-11.7)。病人常發生的副作用以皮疹11人(50%)和腹瀉10人(45%)為最多，並且有2位病人分別發生手足皮膚反應和瀰漫性頭皮結痂是erlotinib較少被文獻描述到的不良反應。結論：本篇以erlotinib治療肺腺癌EGFR野生型病人，發現部分病人在治療反應上呈現穩定狀態，推測erlotinib的治療效益可能不侷限於EGFR基因為突變型病人，但相關研究仍須進一步確認。

關鍵字

非小細胞肺癌 ； 表皮生長因子接受器 ； 表皮生長因子接受器野生型 ； Erlotinib

並列摘要

Objective: Recent studies show that erlotinib, a tyrosine kinase inhibitor targeted therapy, have been explored in the treatment of epidermal growth factor receptor (EGFR) wild-type. In Taiwan, most patients with lung adenocarcinoma belong to the EGFR mutation and documentation on erlotinib use in EGFR wild-type is sparse. Therefore, this study investigated the efficacy and adverse reactions of erlotinib used by such patients in a Taiwan medical center. Methods: This study was conducted from October 2013 to May 2016 with the patients’ eligibility criteria: lung adenocarcinoma with stage IIIB/IV or postoperative recurrence, tumors with EGFR wild-type by EGFR gene detection methods. Patients were given systemic chemotherapy prior to taking erlotinib. Patients discontinued the erlotinib 150 mg daily tablet until the disease progressed or when the side effects could not be endured further. Results: 22 patients were enrolled in the study. Median age was 64 years (35-81 years). Overall response rate and disease control rate for the patients were 27% and 68.1%, respectively. Median for progression-free survival and event-free survival were 5.5 months (95% confidence interval [CI]: 0.00-12.2) and 6.1 months (95% CI: 0.4-11.7). The most common side effects were skin rashes, in 11 patients (50%) and diarrhea, in 10 patients (45%). 2 patients developed hand-foot skin reactions and diffuse scalp crusting, rare adverse reactions mentioned in the documentation. Conclusions: The study showed some patients were in stable condition following the erlotinib treatment. Thus, the effect of erlotinib may not be limited to EGFR mutation-patients only. However, relevant research need to be further confirmed.

並列關鍵字

Non-Small Cell Lung Aancer ； Epidermal Growth Factor Receptor ； Epidermal Growth Factor Receptor Wild-Type ； Erlotinib