EGFR-TKIs与化疗比较一线治疗非小细胞肺癌疗效的meta分析

背景与目的表皮因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitor,EGFR-TKI)应用于非小细胞肺癌(non-small cell lung cancer,NSCLC)一线治疗取得较好的临床疗效,然而EGFR-TKI一线用药选择仍面临很多问题。本研究应用循证医学的方法对NSCLC患者临床特征及基因突变情况对一线EGFRTKIs治疗及化疗获益进行分析,以便指导临床用药。方法用计算机检索Pubmed、Embase、American Society of Clinical Oncology(ASCO)、European Society for Medical Oncology(ESCO)及生物医学数据库等数据库,寻找出EGFR-TKI与化疗相比一线治疗NSCLC的疗效的随机对照研究(randomized controlled trials,RCT)。对纳入RCT进行资料提取和质量评价,采用Review Manager 5.2软件分析、对比NSCLC患者在TKI治疗中的疗效。结果纳入的14项研究,共5,000例患者。Meta分析结果显示,EGFR基因突变的NSCLC患者,EGFR-TKIs治疗与化疗相比有较好的近期有效率(RR=2.31;95%CI:1.88-2.84)和延长无疾病进展时间(progression free survival,PFS)(HR=0.39;95%CI:0.30-0.49),总生存时间(overall survival,OS)上两者无明显差异(HR=0.99;95%CI:0.84-1.16)。临床选择(亚裔、腺癌、不吸烟)NSCLC患者,EGFR-TKIs一线治疗与化疗相比也有较好的近期有效率(RR=1.30;95%CI:1.15-1.47),PFS和OS无差异(HR=0.93;95%CI:0.58-1.49)(HR=0.91;95%CI:0.81-1.02)。未经选择的患者,一线EGFR-TKIs治疗有效率、PFS与化疗无差异,但OS劣于一线接受化疗患者。结论 EGFR突变的NSCLC患者一线EGFR-TKIs获益更多;对于不能耐受化疗的亚裔、腺癌、不吸烟患者,推荐一线EGFR-TKIs治疗;未经选择的NSCLC患者一线EGFR-TKIs治疗临床无获益,而且一线EGFR-TKI治疗的OS明显低于一线化疗。     

191例EGFR突变状态不明晚期肺腺癌患者EGFR-TKIs耐药后化疗的疗效分析

背景与目的晚期肺腺癌患者在使用表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitors,EGFR-TKIs)治疗进展后需要接受化疗。本研究旨在探讨EGFR-TKIs耐药后进行化疗的疗效影响因素。方法回顾性分析191例晚期肺腺癌患者的临床特征、EGFR-TKIs耐药后第一次化疗的近期疗效及生存时间。结果含培美曲塞方案的有效率明显高于不含培美曲塞组,客观缓解率(objective response rate,ORR)分别为9.3%和1.1%(P=0.011),以二线化疗更为明显,ORR分别为14.3%和3.7%(P=0.041)。化疗最好疗效达部分缓解(partial response,PR)者的无进展生存期(progression-free survival,PFS)明显长于未达到PR者(PFS分别为10.1个月和2.3个月,P=0.012);含铂方案的PFS及总生存期(overall survival,OS)均长于不含铂方案,是独立的预后因素[PFS:相对风险(relative risk,RR)=0.634,95%CI:0.466-0.832,P=0.004;OS:RR=0.666,95%CI:0.460-0.960,P=0.030],其中TKIs获得性耐药的患者和爆发式进展的患者进行含铂化疗生存获益更多。TKIs耐药的性质(原发或获得性)及TKIs耐药模式(爆发进展、缓慢进展和局部进展)对后续化疗的ORR、PFS及OS均无明显影响。结论对于EGFR-TKIs耐药的晚期肺腺癌患者,含培美曲塞方案和含铂方案可能疗效较好。     

全脑放疗时间对EGFR突变非小细胞肺癌脑转移患者生存的影响

背景与目的全脑放疗（whole brain radiotherapy, WBRT）在表皮生长因子受体（epidermal growth factor receptor,EGFR）突变的非小细胞肺癌（non-small cell lung cancer, NSCLC）脑转移患者治疗中何时应用尚无高级别的循证医学证据。本研究旨在探讨WBRT的参与时间对携有EGFR突变的NSCLC脑转移患者生存的影响。方法2009年8月-2015年5月在我院确诊的EGFR突变伴脑转移的晚期NSCLC共78例患者,均接受WBRT及EGFR酪氨酸激酶抑制剂（EGFR tyrosine kinase inhibitors, EGFR-TKIs）治疗的48例初治患者进入临床分析,采用Cox比例风险模型分析患者颅内无进展生存期（progression-free survival, PFS）及总生存期（overall survival, OS）的影响因素。结果全组患者颅内客观缓解率（objective response rate, ORR）为81.3%,颅内疾病控制率（disease control rate, DCR）为93.8%,中位颅内PFS为10个月,中位OS为18个月。颅内PFS的多因素分析显示,美国东部肿瘤协作组评分（Eastern Cooperative Oncology Group performance status, ECOG PS）0分-1分（HR=30.436,95%CI：4.721-196.211,P<0.001）及早期WBRT患者（HR=3.663,95%CI：1.657-8.098,P=0.001）的颅内PFS更佳。OS的多因素分析显示,ECOG PS 0分-1分（HR=57.607,95%CI：6.135-540.953,P<0.001）、早期WBRT（HR=2.757,95%CI：1.140-6.669,P=0.024）及立体定向放射外科（stereotaxic radio surgery, SRS）的应用（HR=5.964,95%CI：1.895-18.767,P=0.002）是患者OS的独立预后因素。结论早期WBRT联合TKIs治疗可改善EGFR突变的NSCLC脑转移患者的预后,尚有待大样本的前瞻性临床试验验证。     

伴有EGFR突变的非小细胞肺癌血清CYFRA21-1和CEA水平与EGFR-TKIs的疗效关系

背景与目的表皮生长因子受体-酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs）是EGFR基因突变晚期非小细胞癌（non-small cell lung cancer, NSCLC）患者一线标准治疗方案，但是临床实践中，疗效差异较大。本项实验拟研究治疗前血清细胞角蛋白19片段（cytokeratin-19 frag-ments, CYFAR21-1）和癌胚抗原（carcinoembryonic antigen, CEA）的水平是否与EGFR-TKIs疗效有关。方法回顾性分析194例EGFR基因突变阳性且接受EGFR-TKIs治疗的NSCLC患者的治疗前的血清CYFAR21-1和CEA水平与EGFR-TKIs疗效及生存时间的关系。结果血清水平CYFAR21-1增高和正常的无进展生存时间（progression-free survival, PFS）分别为7.0个月和11.9个月（P<0.001）；总生存（overall survival, OS）分别为12.6个月和28.0个月（P<0.001）。腺癌中，血清水平增高和正常的PFS分别为7.0个月和12.0个月（P<0.001），OS分别为13.1个月和28.1个月（P<0.001）。鳞癌中，血清CYFRA21-1水平高低与生存时间无关。治疗前血清CEA水平高低与生存时间无关。结论在EGFR突变肺腺癌患者，治疗前血清水平CYFAR21-1增高组EGFR-TKIs治疗的PFS和OS均较正常组短。EGFR突变肺腺癌患者，治疗前血清CYFAR21-1水平可以作为预测EGFR-TKIs治疗的疗效指标。     

血脂与接受EGFR-TKIs治疗的Ⅳ期非小细胞肺癌患者预后的相关性

目的:探讨血脂与接受EGFR-TKIs治疗的IV期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者生存预后的相关性。方法:回顾性收集EGFR-TKIs治疗的IV期EGFR突变的NSCLC患者的临床资料、首次治疗前血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)]水平,随访无疾病进展生存期(PFS)和总生存期(OS),用Rstudio(survminer包)软件确定治疗前各血脂最佳截断值,Kaplan-Meier法绘制生存曲线,COX回归分析影响患者PFS、OS的预后因素。结果:共纳入90例NSCLC患者,19外显子缺失41例,21外显子L858R阳性39例,其他类型突变10例;接受埃克替尼、吉非替尼或其他EGFR-TKIs作为首次抗肿瘤治疗的患者分别为31例、41例、18例。治疗前TC≥4.08mmol/L、HDL-C≥1.20 mmol/L组较对照组PFS和OS延长(P <0.001),多因素COX风险模型分析显示初治前血清TC、HDL-C高水平组是接受EGFR-TKIs治疗IV期NSCLC患...     

晚期非小细胞肺癌表皮生长因子受体基因突变情况和其对吉非替尼疗效的影响

背景与目的 研究晚期非小细胞肺癌( non-small cell lung cancer,NSCLC)表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变情况和该基因突变状态对吉非替尼疗效的影响.方法 于2007年1月-2009年12月对160例晚期非鳞癌NSCLC患者进行了EGFR基因检测,EGFR基因外显子19和外显子21突变检测采用突变富集PCR法.其中111例接受了吉非替尼治疗.中位生存期(overall survival,OS)和无疾病进展生存时间(progression free survival,PFS)的比较采用Kaplan-Meier方法计算.结果 晚期非鳞癌NSCLC患者EGFR基因突变率为55％,多因素分析显示只有病理类型与是否突变明显相关.EGFR基因突变型患者的OS为29.0个月(95％CI:24.2-33.8),野生型为21.0个月( 95％CI:14.7-27.3),两者差别无统计学差异.EGFR基因突变患者的PFS为17.0个月(95％CI:5.6-17.6),而野生型为11.6个月(95％CI:8.6-25.4),两者有明显性差别(P=0.022).OS的多因素分析结果显示,OS与ECOG评分、病理类型、EGFR基因突变状态明显相关.PFS多因素分析结果显示,PFS与ECOG评分、既往化疗方案数和EGFR基因突变明显相关.EGFR基因外显子19突变与外显子21突变的OS和PFS无明显差别,客观疗效也无差别.结论 晚期非鳞癌NSCLC EGFR基因突变患者的PFS明显优于野生型患者,OS有延长趋势.EGFR基因不同突变类型的PFS和OS均无差别.     

初治晚期无症状脑转移非小细胞肺癌患者全脑放疗的时序探讨

目的:探讨无症状脑转移非小细胞肺癌(non-small cell lung cancer,NSCLC)患者进行全脑放疗(whole brain radiation therapy,WBRT)的时序.方法:对102例经CT或MRI确诊的无症状脑转移NSCLC患者进行回顾性分析,根据WBRT的时序进行分组:化疗后行WBRT(A组)、先WBRT后化疗(B组)和同步WBRT和化疗(C组).结果:A、B和C组的无进展生存(progression-free survival,PFS)时间分别为4.5、6.1和5.6个月(P=0.50),总生存(overall survival, OS)时间分别为11.1、13.0和11.7个月(P=0.18).3组患者治疗后的3～4级不良反应发生率经比较差异无统计学意义. 结论:先WBRT后行化疗可能有延长无症状脑转移NSCLC患者PFS和OS的趋势,但各组之间的生存时间和不良反应差异无统计学意义.     

EGFR基因突变型与野生型非小细胞肺癌脑转移预后的病例对照研究

目的：探讨表皮生长因子受体（epidermal growth factor receptor,EGFR）基因突变与非小细胞肺癌（non-small cell lung cancer,NSCLC）伴脑转移患者预后的相关性,为改善NSCLC合并脑转移患者预后、指导个体化治疗提供临床依据。方法：回顾性分析福建省立医院2013年1月1日至2018年9月30日期间收治的88例NSCLC合并脑转移患者的临床资料,随访取得患者的死亡时间,随访截止日期为2019年10月31日。收集和分析的临床资料包括性别、年龄、吸烟史、病理类型、基因检测、治疗情况、无进展生存期（progression free survival,PFS）、总生存期（overall survival,OS）等。运用生存分析（Kaplan-Meier生存时间曲线）评价EGFR突变型患者的预后,以单因素分析（log-rank检验）预测影响EGFR-TKI治疗效果的因素。结果：88例NSCLC脑转移患者有57例为EGFR突变型,其中位PFS（MPFS）为13.0个月（95%CI：11.951~14.049）,明显高于EGFR野生型患者（P=0.003）,患者中位生存期（median survival time,MST）为29.0个月（95%CI：20.531~37.468）,明显高于EGFR野生型（P=0.001）。EGFR突变型中,Exon19-del突变组患者较Exon21 L858R突变组患者OS有延长趋势（P=0.05）,Exon19-del+Exon20T790M突变组患者OS较Exon21 L858R突变组有延长趋势（P=0.077）。结论：EGFR突变组较野生型组NSCLC脑转移患者预后相对好些,且携带19外显子单一缺失突变的患者预后最好。     

厄洛替尼治疗晚期非小细胞肺癌分类及回归树分析

背景与目的 厄洛替尼是治疗非小细胞肺癌(non-small cell lung cancer,NSCLC)的靶向药物.已有研究表明具有不同临床特征的患者对厄洛替尼的生存获益存在差异,但结论并不一致.本研究将探索厄洛替尼治疗晚期NSCLC生存时间的预测因素以及这些因素的相互影响.方法 对2006年9月-2009年9月在中国医学科学院肿瘤医院使用厄洛替尼治疗的晚期NSCLC患者的临床及生存资料采用分类及回归树分析(classification and regression tree,CART).结果 105例患者的中位无肿瘤进展生存时间(progressive-free survival,PFS)为5.0个月(95%CI:2.9-7.1).CART分析将淋巴结分期、厄洛替尼治疗时机及吸烟状况分别作为第一、二、三级划分位点,逐级获得4个终末亚组.生存时间较长的是无淋巴结转移或有淋巴结转移、厄洛替尼治疗≤二线并且吸烟≤35包年的两组患者,中位PFS分别为11.0个月(95%CI:8.9-13.1)和10.0个月(95%CI:7.9-12.1),而生存时间较短的是有淋巴结转移且厄洛替尼的治疗＞二线或有淋巴结转移、厄洛替尼治疗≤二线并且吸烟＞35包年的两组患者,中位PFS分别为2.3个月(95%CI:1.6-3.0)和1.3个月(95%CI:0.5-2.1).结论 是否存在淋巴结转移、厄洛替尼治疗时机以及既往吸烟状况是影响厄洛替尼治疗PFS的主要因素.CART可以找出既往被我们忽略的亚组患者,有利于为临床实践及今后临床研究找到同质性的患者群体.     

不同基因分型晚期非小细胞肺癌患者的预后分析

背景与目的 非小细胞肺癌(non-small cell lung cancer,NSCLC)已由原来的组织分型指导下的治疗转变为基因分型指导治疗的模式,表皮生长因子受体(epidermal growth factor receptor,EGFR)和间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)是肺癌最重要的两个驱动基因.本研究旨在探讨不同基因分型的复发或转移晚期NSCLC患者的临床特点及预后影响因素.方法 回顾性分析北京胸科医院2004年7月-2015年12月间553例EGFR和ALK基因状态明确的晚期NSCLC患者的临床资料,采用Cox比例风险回归模型对患者预后的独立影响因素进行分析.结果 553例细胞学或组织学证实的晚期NSCLC患者,EGFR突变患者227例,ALK阳性患者58例,EGFR和ALK双突变患者2例,EGFR和ALK野生型患者266例.227例EGFR突变患者的中位生存期(overall survival,OS)为28.7个月(95%CI:22.160-35.240),体能状态(performance status,PS)评分为0分-1分(HR=4.451;95%CI:2.112-9.382;P<0.001)、接受EGFR-酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKIs)靶向治疗(HR=2.785;95%CI:1.871-4.145;P<0.001)是EGFR突变患者生存的独立影响因素.58例ALK阳性患者的中位OS为15.5个月(95%CI:10.991-20.009),接受克唑替尼靶向治疗(P=0.022)是ALK阳性患者生存的独立影响因素.266例野生型患者的中位OS为12.1个月(95%CI:10.660-13.540),PS评分为0分-1分(HR=2.313;95%CI:1.380-3.877;P=0.001)、接受化疗(HR=1.911;95%CI:1.396-2.616;P<0.001)是野生型患者生存的独立影响因素.结论 不同基因型的晚期NSCLC患者的预后差异较大,靶向治疗可改善EGFR突变、ALK阳性患者生存.     

Prognostic factors to predict survival in non-small-cell lung cancer with brain metastasis

Objective： The purpose of the study was to assess prognostic factors to predict overall survival （OS） and progres- sion-free survival （PFS） in non-small-cell lung cancer （NSCLC） with brain metastasis （BM）. Methods： From November 2011 to March 2013, the clinical data of 31 NSCLC cases with BM treated with multiple modalities including brain radiotherapy alone, systemic chemotherapy, whole brain radiotherapy （WBRT） combined with tyrosine kinase inhibitor （TKIs）. The efficacy and adverse reaction were evaluated after treatment. Results： In terms of intracranial lesions, the objective response rate （ORR） and the disease control rate （DCR） were 22.6% and 90.3%, respectively. As for systemic disease, ORR and DCR were 32.3% and 93.5%, respectively. The median time to progression-free survival （PFS） was 298 days （95% CI： 258.624-337.376 days）, whereas in the epidermal growth factor receptor （EGFR） mutation patients was 331 days. Patients who received EGFR-TKIs combined with brain radiation had better response rate （RR） than those only brain radiation. Univariate analysis showed that the EGFR-mutations could predictive factors for PFS, and not to other clinical pathological features. The most common toxicities were rash and diarrhea, but all were well-tolerated. Conclusion： EGFR-mutations is the independent prognostic factors affecting the survival rates of NSCLC patients with BM. Through the clinical observation, icotinib combined with WBRT may be effective on brain metastases in NSCLC patients, and toxicities are tolerable, which worth further study.     

NLR和LMR对EGFR-TKIs治疗EGFR突变阳性非小细胞肺癌预后的预测价值

目的:探讨治疗前血清中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）和淋巴细胞与单核细胞比值（lympho cyte to monocyte ratio,LMR）对表皮生长因子受体-酪氨酸激酶抑制剂（epidermal growth factor receptor-tyrosine kinase inhibitors,EGFR-TKIs）治疗EGFR突变阳性非小细胞肺癌（non-small cell lung cancer,NSCLC)患者预后的预测价值。方法:回顾性分析112例EGFR突变阳性并接受了EGFR-TKIs治疗的Ⅳ期NSCLC患者的临床资料,根据接受者操作特征曲线（ROC）分析确定的NLR和LMR的最佳分界值,将患者分为高、低水平两组,比较不同分组之间的无进展生存时间（progression free survival,PFS）和总生存时间（overall survival,OS）,通过Cox比例风险模型分析影响PFS和OS的独立预后因素。结果:根据ROC曲线,NLR=2.92,LMR=3.81作为评价的分界值。低NLR组和高NLR组的PFS分别为15.6个月和10.5个月（P＜0.001）,OS分别为26.9个月和19.3个月（P=0.003）;高LMR组和低LMR组的PFS分别为13.4个月和11.5个月（P=0.024）,OS分别为26.2个月和21.8个月（P=0.020）。通过多因素分析发现,ECOG评分和NLR是影响患者PFS和OS的独立预后因素。结论:治疗前血清NLR水平可作为预测EGFR-TKIs治疗EGFR突变阳性Ⅳ期NSCLC患者的预后因子。     

EGFR-TKIs plus local therapy demonstrated survival benefit than EGFR-TKIs alone in EGFR-mutant NSCLC patients with oligometastatic or oligoprogressive liver metastases

To investigate whether addition of local therapy to EGFR-TKIs could provide survival benefit than EGFR-TKIs alone in EGFR-mutant NSCLC patients with oligometastatic or oligoprogressive liver metastases (LM). Patients with EGFR-mutant NSCLC and oligometastatic or oligoprogressive LM who met inclusion criteria were retrospectively identified. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS) and patterns of failure. Addition of local therapy was associated with a significantly longer PFS (13.8 vs. 8.6 m, p <0.001) and OS (31.2 vs. 18.5 m, p <0.001) in whole group. In oligometastatic cohort, 20 patients received EGFR-TKIs and 23 received EGFR-TKIs plus local therapy as first-line treatment. Addition of local therapy showed a significantly longer PFS (12.9 vs. 7.9 m, p = 0.041) and OS (36.8 vs. 21.3 m, p = 0.034) than EGFR-TKIs alone. In oligoprogressive cohort, 24 patients received continuation of EGFR-TKIs plus local therapy and 25 received switching chemotherapy. Median PFS2 (13.9 vs. 9.2 m, p = 0.007) and OS (28.3 vs. 17.1 m, p = 0.011) was significantly longer in combined group than in switching chemotherapy group. Distant metastatic sites progression was the major pattern of failure in combined group while locoregional recurrence was the major reason in monotherapy or switching chemotherapy group. Our study suggested that EGFR-TKIs plus local therapy showed prolonged survival benefit than EGFR-TKIs alone in EGFR-mutant NSCLC patients with oligometastatic or oligoprogressive LM, indicating addition of local therapy would be alternative choice in this clinical scenario.     

选择性动脉灌注化疗联合靶向药物治疗非小细胞肺癌多发脑转移

背景与目的 本研究旨在回顾性分析选择性动脉灌注化疗联合赖氨酸激酶抑制剂( tyrosine kinase inhibitor,TKI)药物治疗非小细胞肺癌(non-small cell lung cancer,NSCLC)多发脑转移的临床疗效及预后相关因素.方法 自2008年9月-2011年10月共入组31例诊断明确的非小细胞肺癌经CT或MRI证实多发脑转移瘤(＞3个)的患者,行选择性颅内动脉、支气管动脉及相关靶动脉化疗药物灌注化疗2个-6个周期,每周期间隔4周,同步或后续联合厄洛替尼、吉非替尼或埃克替尼治疗.介入治疗2个周期或联合靶向治疗后每4周应用CT和MRI对肿瘤进行疗效评价,直至肿瘤进展或发生不可耐受性化疗药物不良反应.结果 31例患者平均行3个周期介入治疗,随访时间4个-40.9个月,完全缓解5例(16.1％),部分缓解7例(22.6％),疾病稳定11例(35.5％),疾病进展8例(25.8％).客观缓解率( objective response rate,ORR)为38.7％,疾病控制率(disease control rate,DCR)为74.2％.中位无进展生存期(progression free survival,PFS)为13.1个月,中位总生存期(overall survival,OS)为15.1个月.6个月的生存率为79％,1年生存率为61.1％,2年生存率为31.1％.分层分析显示PFS、OS与吸烟状态、病理类型、颅外转移情况、靶向药物应用时间、PS评分具有相关性;与性别、年龄、既往治疗情况、脑转移数目无明显相关.结论 选择性动脉灌注化疗联合靶向药物是治疗非小细胞肺癌多发脑转移安全有效的方法之一,吸烟状态、PS评分、肿瘤病理类型、颅外转移状况、靶向药物应用时间均可影响患者预后.     

甲磺酸奥希替尼治疗EGFR基因突变型非小细胞肺癌脑转移的疗效评价

目的:探讨甲磺酸奥希替尼治疗表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变型非小细胞肺癌(non-small-cell lung cancer,NSCLC)脑转移的临床效果及预后因素.方法:回顾分析2017年5月-2019年12月60 例由蚌埠医学院第一附属医院肿...     

Epidermal growth factor receptor-tyrosine kinase inhibitor therapy is effective as first-line treatment of advanced non-small-cell lung cancer with mutated EGFR: A meta-analysis from six phase III randomized controlled trials

Gefiinib and erlotinib are two similar small molecules of selective and reversible epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), which have been approved for second-line or third-line indication in previously treated advanced Non-small-cell lung cancer (NSCLC) patients. The results of comparing the EGFR-TKI with standard platinum-based doublet chemotherapy as the first-line treatment in advanced NSCLC patients with activated EGFR mutation were still controversial. A meta-analysis was performed to derive a more precise estimation of these regimens. Finally, six eligible trials involved 1,021 patients were identified. The patients receiving EGFR-TKI as front-line therapy had a significantly longer progression-free survival (PFS) than patients treated with chemotherapy [median PFS was 9.5 versus 5.9 months; hazard ratio (HR)=0.37; 95% confidence intervals (CI)=0.27-0.52; p<0.001]. The overall response rate (ORR) of EGFR-TKI was 66.60%, whereas the ORR of chemotherapy regimen was 30.62%, which was also a statistically significant favor for EGFR-TKI [relative risk (RR)=5.68; 95% CI=3.17-10.18; p<0.001]. The overall survival (OS) was numerically longer in the patients received EGFR-TKI than patients treated by chemotherapy, although the difference did not reach a statistical significance (median OS was 30.5 vs. 23.6 months; HR=0.94; 95% CI=0.77-1.15; p=0.57). Comparing with first-line chemotherapy, treatment of EGFR-TKI achieved a statistical significantly longer PFS, higher ORR and numerically longer OS in the advanced NSCLC patients harboring activated EGFR mutations, thus, it should be the first choice in the previously untreated NSCLC patients with activated EGFR mutation.     

非小细胞肺癌脑转移患者全脑放疗不同剂量预后分析

目的:分析非小细胞肺癌(NSCLC)脑转移患者不同全脑放疗(WBRT)剂量的预后及影响因素。方法:回顾性分析2013—2015年间于河北医科大学第四医院行WBRT的244例NSCLC脑转移患者。按照不同WBRT剂量(EQD 2Gy)分为30~39 Gy组104例、≥40 Gy组140例。比较两组患者颅内无进...     

A prospective observational registry evaluating clinical outcomes of Radium-223 treatment in a nonstudy population

The ALSYMPCA study established a 3.6 month Overall Survival (OS) benefit in metastatic Castration Resistant Prostate Cancer (mCRPC) patients treated with Radium-223 dichloride (Ra-223) over placebo. Here we report clinical outcomes of Ra-223 treatment in a nonstudy population. In this prospective registry, patients from 20 Dutch hospitals were included prior to Ra-223 treatment. Clinical parameters collected included previous treatments and Adverse Events. Primary outcome was 6 months Symptomatic Skeletal Event (SSE)-free survival, while secondary outcomes included Progression-Free Survival (PFS) and Overall Survival (OS). Of the 305 patients included, 300 were evaluable. The mean age was 73.6 years, 90% had ≥6 bone metastases and 74.1% were pretreated with Docetaxel, 19.5% with Cabazitaxel and 80.5% with Abiraterone and/or Enzalutamide. Of all patients, 96.7% were treated with Ra-223 and received a median of 5 cycles. After a median follow-up of 13.2 months, 6 months SSE-free survival rate was 83%, median PFS was 5.1 months and median OS was 15.2 months. Six months SSE-free survival rate and OS were comparable with those reported in ALSYMPCA. “Previous Cabazitaxel treatment” and “bone-only metastases” were independent predictors of a shorter and longer PFS, respectively, while above-median LDH and “bone-only metastases” were independent predictors of shorter and longer OS, respectively. Toxicity was similar as reported in the ALSYMPCA trial. These results suggest that in a nonstudy population, Ra-223 treatment is well-tolerated, equally effective as in the ALSYMPCA population and that patients not previously treated with Cabazitaxel benefit most from Ra-223.