Erlotinib or Chemotherapy in Second-Line or Later Treatment of Tumor EGFR Wild-Type Pulmonary Adenocarcinoma Patients

使用Erlotinib或化學治療作為野生型上皮細胞生長因素接收器之肺腺癌患者的第二線或後線之治療

陳育民(Yuh-Min Chen) ； 羅永鴻(Yung-Hung Luo) ； 吳杰鴻(Chieh-Hung Wu) ； 李毓芹(Yu-Chin Lee) ； 彭瑞鵬(Reury-Perng Perng) ； 彭汪嘉康(Jacqueline Whang-Peng)

《台灣癌症醫學雜誌》 2卷1期 (2015/03) Pp. 3-11

https://doi.org/10.6323/JCRP.2015.2.1.01

摘要

本研究之目的是探討野生型上皮細胞生長因素接收器之肺腺癌患者於第一線化學治療失敗之後，使用erlotinib，pemetrexed，或docetaxel的治療效果差異。我們於民國98年7月至101年6月期間，收集了41個患者作分析，所有人於病程中皆有使用到erlotinib，35人有使用pemetrexed，30人有使用docetaxel。其中erlotinib較常使用於第二線的治療（27人，65.9%），pemetrexed較常用於第三線治療（21人，60%），docetaxel常常用於第四線的治療（14人，46.7%）(當比較不同的治療藥物時，p值皆小於0.01)。這三種藥物的腫瘤反應率並無顯著之差異（erlotinib（19.5%），pemetrexed（17.1%），docetaxel（6.7%），p=0.301）。這些藥物使用在第二線或更後線治療的無疾病進展存活時間中位數有顯著之差異（erlotinib（10.9週），pemetrexed（13.3週），docetaxel（8.3週），p=0.0261）。這些藥物使用於較前線或較後線之挽救性治療的無疾病進展存活時間並無顯著之差異。所以野生型上皮細胞生長因素接收器之肺腺癌患者於第一線化學治療失敗之後，不論使用erlotinib，pemetrexed，或docetaxel，皆為有效之挽救性治療。

關鍵字

腺癌 ； 非小細胞肺癌

並列摘要

Background: The intent of this study was to explore the treatment efficacy of erlotinib, pemetrexed or docetaxel in individual patients with tumor EGFR wild-type pulmonary adenocarcinoma who failed previous chemotherapy. Methods: We retrospectively reviewed the clinical data of our EGFR wild-type pulmonary adenocarcinoma patients who had disease progression after first-line chemotherapy and also had received erlotinib and pemetrexed or docetaxel treatment in our institution any time from July 2009 to June 2012. Results: Forty-one patients were identified and enrolled into the present study; all of them received erlotinib treatment. Thirty-five patients received additional pemetrexed treatment and 30 patients received additional docetaxel treatment, either preceding or following failure of erlotinib treatment. Erlotinib was used more frequently as a second-line treatment in 27 of 41 (65.9%) patients, followed by pemetrexed, which was used more frequently in the third-line setting for 21 of 35 (60%) patients. Docetaxel was typically used as the fourth-line treatment for 14 of 30 (46.7%) patients (all p＜0.01 when comparing different treatment agents). There was no difference in the tumor response rate between erlotinib (19.5%), pemetrexed (17.1%), and docetaxel (6.7%) (p=0.301). For all patients, the median progression-free survival (PFS) was 10.9 weeks, 13.3 weeks, and 8.3 weeks when using erlotinib, pemetrexed, and docetaxel, respectively, as≥second-line treatment (p=0.0261). No significant difference in PFS was found for individual agents when used in an earlier or later line of salvage therapy. Conclusions: This retrospective study of tumor EGFR wild-type pulmonary adenocarcinoma patients showed that erlotinib, pemetrexed, or docetaxel, individually, provided effective salvage therapy when patients had disease progression subsequent to first-line chemotherapy.

並列關鍵字

adenocarcinoma ； docetaxel ； erlotinib ； non-small-cell lung cancer ； pemetrexed