EGFR突变NSCLC脑转移靶向治疗同步WBRT必要性研究

目的 通过比较WBRT联合TKI与单纯TKI对EGFR突变NSCLC脑转移预后的影响,探讨靶向治疗同步联合WBRT的必要性。方法 回顾分析2010—2014年间43例EGFR突变NSCLC脑转移病例,24例WBRT+TKI,19例单纯TKI。结果 全组24例WBRT+TKI和19例单纯TKI的有效率分别为79%和37%(P=0.002),6个月LC率分别为79%、63%(P=0.008),中位PFS期分别为23.7、8.3个月(P=0.025)。多因素分析显示原发灶控制、WBRT+TKI、脑转移灶单发是PFS有利因素(P=0.033、0.019、0.019)。23例19外显子缺失患者中12例WBRT+TKI、11例单纯TKI的有效率分别为100%、35%(P=0.000),6个月LC率分别为100%、55%(P=0.008),中位PFS期分别为23.7、8.4个月(P=0.003)。20例非19外显子缺失患者中12例WBRT+TKI、8例TKI的有效率分别为64%、50%(P=1.000),6个月LC率分别为58%、75%(P=0.642),中位PFS期分别为14.4、8.4个月(P=0.864)。结论 WBRT联合TKI治疗NSCLC脑转移优于单纯TKI,19外显子缺失患者可能获益更明显。

The necessity of EGFR-targeted therapy combined with synchronized whole brain radiotherapy for non-small-cell lung cancer with mutated EGFR and brain metastasis

Objective To explore the necessity of EGFR-targeted therapy combined with synchronized whole brain radiotherapy (WBRT) for non-small-cell lung cancer (NSCLC) with mutated EGFR and brain metastasis by comparing the effects on prognosis between WBRT combined with tyrosine kinase inhibitor (TKI) and TKI alone. Methods A retrospective analysis was performed in 43 patients with EGFR mutation-positive NSCLC and brain metastasis. In those patients, 24 patients received WBRT plus TKI and 19 patients TKI alone. Results The overall response rate (RR) and 6-month intracranial disease control rate (CR) were significantly higher in the WBRT+TKI group than in the TKI group (79% vs. 37%, P=0.002;79% vs. 63%, P=0.008). The median intracranial progression-free survival (IPFS) time was significantly longer in the WBRT+TKI group than in the TKI group (23.7 vs. 8.3 months, P=0.025). The multivariate analysis indicated that the control of lung cancer, WBRT+TKI, and single brain metastasis were favorable factors for substantially longer IPFS time (P=0.033,0.019,0.019). In 23 patients with exon 19 deletion, 12 patients received WBRT+TKI and 11 patients TKI alone;compared with the TKI group, the WBRT+TKI group had significantly higher RR and 6-month CR as well as significantly longer IPFS (100% vs. 35%, P=0.000;100% vs. 55%, P=0.008;23.7 vs. 8.4 months, P=0.003). In 20 patients without exon 19 deletion, however, there were no significant differences in RR or 6-month CR between the WBRT+TKI group (n=12) and the TKI group (n=8)(64% vs. 50%, P=1.000;58% vs. 75%, P=0.642).The median IPFS was 14.4 and 8.4 months (P=0.864). Conclusions WBRT combined with TKI is superior to TKI alone in the treatment of NSCLC with brain metastasis. Patients with exon 19 deletion have substantially better treatment outcomes.