奥希替尼一线治疗EGFR突变型非小细胞肺癌脑转移患者的临床疗效

doi:10.3969/j.issn.2095-1264.2023.03.07

首页 > 过刊浏览>2023年第3期 >305-312. DOI:10.3969/j.issn.2095-1264.2023.03.07

奥希替尼一线治疗EGFR突变型非小细胞肺癌脑转移患者的临床疗效
DOI:
                        10.3969/j.issn.2095-1264.2023.03.07
                    
作者:
                        
                        
                    
作者单位:1.中南大学湘雅医院 肿瘤放疗科，湖南 长沙，410000;2.湘西自治州人民医院 肿瘤科，湖南 吉首，416000
作者简介:吴红花，女，硕士，主治医师，研究方向：肺癌靶向治疗。
通讯作者:周蓉蓉，女，博士，主任医师，博士研究生导师，研究方向：肺癌靶区勾画及AI，肺癌脑转移的基础及临床研究，胸部肿瘤的放化疗及靶向免疫治疗。
中图分类号:R734.2
基金项目:

Clinical efficacy of osimertinib in first-line treatment of EGFR mutant non-small cell lung cancer with brain metastases

Author:

Affiliation:

1.Department of Radiation Oncology, Xiangya Hospital of Central South University, Changsha, 410000, Hunan, China;2.Department of Oncology, Xiangxi Autonomous Prefecture People's Hospital, Jishou, 416000, Hunan, China

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摘要:

目的探讨奥希替尼一线治疗表皮生长因子受体（EGFR）突变敏感的非小细胞肺癌（NSCLC）脑转移患者的临床疗效。方法选取2018年1月至2021年8月在中南大学湘雅医院就诊的EGFR突变并接受奥希替尼一线治疗的NSCLC脑转移患者为研究对象。观察治疗3个月后所有患者的颅内客观缓解率（iORR）、颅内疾病控制率（iDCR），比较不同临床特征患者iORR和iDCR的差异；记录治疗期间不良反应发生率；随访所有患者治疗后疾病进展和死亡情况，并采用COX回归模型分析奥希替尼一线治疗的预后影响因素。结果本研究共纳入82例NSCLC脑转移患者，接受奥希替尼一线治疗3个月后iORR为69.5%，iDCR为96.3%；不同年龄、性别、是否吸烟、PS评分、EGFR突变类型、脑转移部位、是否有其他部位转移、是否有中枢神经症状的NSCLC脑转移患者iORR和iDCR比较，差异均无统计学意义（P>0.05）；治疗期间不良反应总发生率为50.0%；总生存率为73.2%，无进展生存率为78.0%；COX回归分析结果显示，EFGR突变类型为L858R的NSCLC脑转移患者发生死亡的风险是19del突变患者的2.793倍（95% CI： 0.134~0.956， P=0.040），年龄>60岁的NSCLC脑转移患者发生死亡的风险是年龄≤60岁患者的4.385倍（95% CI： 1.267~15.175， P=0.020）。结论奥希替尼一线治疗EGFR突变型NSCLC脑转移患者可获得良好的iORR和iDCR，且安全性较好。EGFR突变类型为L858R和年龄>60岁是NSCLC脑转移患者奥希替尼一线治疗的预后危险因素。

Abstract:

Objective To explore the clinical efficacy of osimertinib in first-line treatment of epidermal growth factor receptor (EGFR) mutation-sensitive non-small cell lung cancer (NSCLC) patients with brain metastases.Methods A total of 82 patients with brain metastases from NSCLC with EGFR mutation and first-line treatment with osimertinib were enrolled in Xiangya Hospital of Central South University between January 2018 and August 2021. The intracranial objective response rate (iORR) and intracranial disease control rate (iDCR) of all patients were observed after 3 months of treatment, and the differences of iORR and iDCR of patients with different clinical characteristics were compared. The incidence of adverse reactions during treatment was calculated. All patients were followed up for disease progression and death after treatment. And COX regression model was used to analyze the prognostic factors after first-line treatment with osimertinib.Results A total of 82 patients with NSCLC brain metastasis were enrolled in this study, the iORR and iDCR were 69.5% and 96.3% after 3 months of osimertinib treatment. There were no significant differences in iORR and iDCR among the patients with different age, sex, smoking status, PS scores, EGFR mutation types, brain metastasis sites, metastasis of other sites, and central nervous symptoms (P>0.05). The incidence of adverse reactions during treatment was 50.0%. The overall survival rate of the patients was 73.2%, and the disease progression-free survival rate was 78.0%. COX regression results showed that the patients with EFGR mutation type L858R had a 2.793-fold increased risk of death as compared with those who had 19del mutation (95% CI: 0.134~0.956, P=0.040), and the patients > 60 years old had a 4.385-fold increased risk of death as compared with those ≤60 years old (95% CI: 1.267~15.175, P=0.020).Conclusion Osimertinib can achieve good iORR and iDCR in first-line treatment of EGFR-mutated NSCLC patients with brain metastasis, with good safety. EGFR mutation type L858R and age >60 years were risk factors for prognosis of NSCLC patients with brain metastasis after first-line treatment with osimertinib.