厄洛替尼治疗非小细胞肺癌脑转移初步分析

The Analysis of Erlotinib on Brain Metastases in Patients with Non-small-cell Lung Cancer

背景与目的非小细胞肺癌(Non-small-cell lung cancer,NSCLC)脑转移较常见,预后不佳。厄洛替尼是一种表皮生长因子受体酪氨酸激酶抑制剂,多应用于治疗晚期NSCLC。本研究拟了解厄洛替尼治疗NSCLC脑转移的疗效、预后及其相关因素。方法回顾性分析30例NSCLC脑转移患者的临床资料,所有患者均口服厄洛替尼150mg/d,直到疾病进展、死亡或发生不可耐受的副反应。结果厄洛替尼对颅内病灶的疗效为部分缓解2例(6.7%),疾病稳定17例(56.7%),疾病控制率为63.4%,对全身病变的总体疗效为部分缓解2例(6.7%),疾病稳定5例(16.7%),疾病控制率为23.4%。年龄、性别、吸烟状况、病理类型、PS评分、脑转移数目、脑转移时间、化疗及脑部放疗与否、副反应等各亚组之间的疗效对比均未见有统计学差异。中位疾病进展时间2.4个月,中位生存期7.7个月,1年、2年生存率分别为38.4%和15.2%。单因素分析显示生存期与患者的PS评分、吸烟状况、是否进行过脑部放疗及化疗具有相关性,多因素分析则显示生存期仅与患者是否进行过脑部放疗具有相关性,与患者的吸烟状况接近有统计学意义。结论厄洛替尼对NSCLC脑转移具有一定的疗效,接受过脑部放疗的患者具有较好的生存获益,非吸烟者的生存时间有好于吸烟者的趋势。厄洛替尼可以作为NSCLC脑转移的一种治疗选择。

Background and objective Brain metastases are common in non-small-cell lung cancer （NSCLC） and the prognosis is poor.Erlotinib is a specific inhibitor of the epidermal growth factor receptor-associated tyrosine kinase （EGFR-TKI）,which has been gradually used in the treatment for advanced NSCLC.The aim of this study is to evaluate the antitumor efficacy and its relevant factors of erlotinib in NSCLC patients with brain metastases.Methods The clinical data of 30 NSCLC patients with brain metastases were reviewed retrospectively.All of them were treated with erlotinib,given orally 150mg daily.These patients discontinued administration of erlotinib until disease progression,death or intolerable side effects.Results In terms of intracranial lesions,partial response （PR） was observed in 2 patients （6.7%）,with stable disease （SD） in 17 patients （56.7%）,for overall disease control rate （DCR） of 63.4%.As for systemic disease,PR was observed in 2 patients （6.7%）,with SD in 5 patients （16.7%）,for overall DCR of 23.4%.There was no statistical difference in DCR among different subtypes of age,gender,smoking history,histology,PS score,the number of brain metastases,the onset of brain metastases,chemotherapy,brain radiotherapy and side effects.The median time to disease progression （MTTP） and median survival time （MST） was 2.4 months and 7.7 months respectively.The 1 and 2 year survival rate was 38.4% and 15.2%.The univariate analysis showed that the survival time was related to the patients＇ PS score,smoking history,brain radiotherapy and chemotherapy.The multivariate analysis indicated that brain radiotherapy was the independent prognostic factor and the relationship between the survival time and smoking history was near to statistical significance.Conclusion The patients receiving brain radiotherapy may have better survival benefit.Non-smokers have a trend to survive longer than smokers.Erlotinib may be effective on brain metastases in NSCLC patients and appears to be a possible new treatment option.