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J Thorac Oncol: 吉非替尼联合同步放疗治疗EGFR突变阳性的局部进展非小细胞肺癌(LA-NSCLC)患者的疗效和安全性:日本西部肿瘤组6911L

2021-06-23 yd2015 MedSci原创

该前瞻性研究表明吉非替尼联合同步放疗治疗EGFR突变阳性的局部进展非小细胞肺癌(LA-NSCLC)患者具有一定疗效并且毒性可耐受。

不可切除局部进展的非小细胞肺癌(LA-NSCLC)的标准治疗为同步放化疗。而2017年PACIFIC研究证实,LA-NSCLC同步放化疗后没有进展的患者durvalumab维持治疗,可以改善预后,取得PFS 17.2个月,2年PFS率为66.3%。我们知道,III期非小细胞肺癌中,腺癌约占40%,而其中的20%-30%伴有EGFR突变。因此,对于EGFR突变阳性的III期非小细胞肺癌的患者较优治疗策略尚不明确。吉非替尼是第一代TKI抑制剂,其相对于化疗,能够改善晚期EGFR突变阳性非小细胞肺癌患者的PFS。因此,来自日本的研究团队假设吉非替尼是否可以替代化疗联合同步放疗,用于EGFR突变阳性的III期不可切除局部进展的非小细胞肺癌患者。近期,研究成果发表在Journal of Thoracic Oncology杂志上。

该研究是开放标签、多中心、单臂的II期临床研究。主要研究终点为2年PFS,次要终点为客观缓解率(ORR), 无进展生存(PFS), 总生存(OS)和安全性。纳入EGFR 敏感突变患者,服用吉非替尼250 mg/日共两年,同步胸部放疗剂量为64Gy。

研究共纳入28例患者,其中27例患者可评估。中位年龄为67岁(range, 45-74); 从不吸烟有15例,现在或既往吸烟的有12例。ECOG 评分0和1分分别有19例和8例患者。EGFR exon 19 deletion / exon 21 L858R分别有13 和14例患者。临床分期IIIA/IIIB分别有14和13例患者。

中位随访时间为51.8个月(range, 34.3-69.0个月)。2年PFS率为29.6%, ORR为81.5% (95% CI: 63.3-91.3%), 中位PFS为18.6个月 (95% CI: 12.0-24.5个月) ,中位OS为61.1个月(95% CI: 38.1 to未达到)。

                      PFS

                     OS

常见的3种不良事件(AEs)为ALT升高(93%), AST升高(89%)和肺炎(89%)。AEs大多为轻度的,没有致死性AEs出现。所有肺炎患者均为轻度,中位治疗时间为92天(range, 43-153天)。21例患者(78%)出现治疗中断,原因多为肺炎和疾病进展。≥3级不良时间为疲劳,皮肤反应和食欲下降。

截止数据分析时,22例患者出现转移复发,伴有25个进展部位。大约一半的患者初始转移部位为孤立性脑转移(n = 12, 48%),大多出现在吉非替尼治疗1年后。21例患者(78%)接受后续治疗。11例脑转移患者,有10例患者接受了立体定向放疗(SBRT),虽然中位PFS不是很显著,但是中位OS似乎较其他转移部位延长(未到达 vs. 50.4个月, HR= 0.15 [0.04-0.68], P = 0.04,)。

            复发转移部位

综上,该前瞻性研究表明吉非替尼联合同步放疗治疗EGFR突变阳性的局部进展非小细胞肺癌(LA-NSCLC)患者具有一定疗效并且毒性可耐受。

原始出处:

Hiroaki Akamatsu, Haruyasu Murakami, Hideyuki Harada,et al. Gefitinib with concurrent thoracic radiotherapy in unresectable locally advanced non-small cell lung cancer with EGFR mutation; West Japan Oncology Group 6911L. J Thorac Oncol. 2021 Jun 8;S1556-0864(21)02190-0.  doi: 10.1016/j.jtho.2021.05.019.

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    2022-02-18 minlingfeng
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    2022-02-26 yyj062
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encryptionId=0b4f65992c, topicName=EGFR突变阳性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri Oct 08 02:52:45 CST 2021, time=2021-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1803562, encodeId=816f1803562ba, content=<a href='/topic/show?id=0b3fe551971' target=_blank style='color:#2F92EE;'>#突变阳性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75519, encryptionId=0b3fe551971, topicName=突变阳性)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKjqGDO7icVKUiaT7urgwXvnvzWtp0fMFU46Xfib8oavFKygiaWtibXReS6ZUh3PImsNicGAwTO5HXxoicnA/132, createdBy=ee262500130, createdName=ms7474195563676018, createdTime=Wed Jul 21 01:52:45 CST 2021, time=2021-07-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1721036, encodeId=0ffd1e2103646, content=<a href='/topic/show?id=634ee040179' target=_blank style='color:#2F92EE;'>#疗效和安全性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70401, encryptionId=634ee040179, topicName=疗效和安全性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=16ef32982072, createdName=经常头晕, createdTime=Tue May 17 22:52:45 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1294620, encodeId=9a2e1294620c9, content=<a href='/topic/show?id=ca6e592189b' target=_blank style='color:#2F92EE;'>#日本#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59218, encryptionId=ca6e592189b, topicName=日本)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f634250, createdName=chentianping, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406060, encodeId=2f1214060606d, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534551, encodeId=e3ce153455193, content=<a href='/topic/show?id=22b3e9887e' target=_blank style='color:#2F92EE;'>#GFR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7988, encryptionId=22b3e9887e, topicName=GFR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0a812532020, createdName=liuyiping, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032975, encodeId=135b10329e502, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 23 23:52:45 CST 2021, time=2021-06-23, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1866123, encodeId=fa4d186612335, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Fri Feb 18 01:52:45 CST 2022, time=2022-02-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2057072, encodeId=89fb205e072b9, content=<a href='/topic/show?id=a19b1e4042f' target=_blank style='color:#2F92EE;'>#THORAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17404, encryptionId=a19b1e4042f, topicName=THORAC)], attachment=null, authenticateStatus=null, createdAvatar=, 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11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406060, encodeId=2f1214060606d, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534551, encodeId=e3ce153455193, content=<a href='/topic/show?id=22b3e9887e' target=_blank style='color:#2F92EE;'>#GFR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7988, encryptionId=22b3e9887e, topicName=GFR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0a812532020, createdName=liuyiping, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032975, encodeId=135b10329e502, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 23 23:52:45 CST 2021, time=2021-06-23, status=1, ipAttribution=)]
    2021-06-25 chg122
  9. 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11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406060, encodeId=2f1214060606d, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534551, encodeId=e3ce153455193, content=<a href='/topic/show?id=22b3e9887e' target=_blank style='color:#2F92EE;'>#GFR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7988, encryptionId=22b3e9887e, topicName=GFR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0a812532020, createdName=liuyiping, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032975, encodeId=135b10329e502, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 23 23:52:45 CST 2021, time=2021-06-23, status=1, ipAttribution=)]
    2021-06-25 liuyiping
  10. 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11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1406060, encodeId=2f1214060606d, content=<a href='/topic/show?id=a5404e589d7' target=_blank style='color:#2F92EE;'>#局部#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47589, encryptionId=a5404e589d7, topicName=局部)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d14c2562456, createdName=chg122, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534551, encodeId=e3ce153455193, content=<a href='/topic/show?id=22b3e9887e' target=_blank style='color:#2F92EE;'>#GFR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7988, encryptionId=22b3e9887e, topicName=GFR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0a812532020, createdName=liuyiping, createdTime=Fri Jun 25 11:52:45 CST 2021, time=2021-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032975, encodeId=135b10329e502, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed Jun 23 23:52:45 CST 2021, time=2021-06-23, status=1, ipAttribution=)]
    2021-06-23 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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