厄洛替尼对非小细胞肺癌脑转移放疗后复发/进展的疗效观察

Effective Observation of Erlotinib for Recurrence/Progression in Patients with Nonsmall Cell Lung Cancer with Brain Metastases After Radiotherapy

目的评价厄洛替尼治疗非小细胞肺癌(NSCLC)脑转移放疗后复发/进展的疗效和不良反应。方法回顾性分析37例NSCLC脑转移放疗后复发/进展患者的临床资料。全部患者均接受厄洛替尼150 mg.d-1口服治疗,8周后评价疗效和不良反应。结果携带EGFR基因外显子19/21突变者13例,状态不详者24例。全部患者颅内转移灶的疾病控制率为56.7%,其中部分缓解5例(13.5%),稳定16例(43.3%);突变组部分缓解、稳定分别为3,8例,状态不详组部分缓解、稳定分别为2,8例。全部患者全身病变的疾病控制率为40.5%,其中部分缓解3例(8.1%),稳定12例(32.4%);突变组部分缓解、稳定分别为2,7例,状态不详组部分缓解、稳定分别为1,5例。突变组较状态不详组疗效差异有统计学意义(P<0.05)。不良反应主要表现为Ⅰ或Ⅱ度的乏力24例(64.9%)、皮疹16例(43.2%)与腹泻8例(21.6%),突变组较状态不详组皮疹发生率差异有统计学意义(P<0.05)。结论厄洛替尼对NSCLC脑转移放疗后复发/进展患者有一定的疗效,对EGFR突变患者疗效更佳,且不良反应较轻,可以作为NSCLC脑转移放疗后复发/进展者的一种治疗选择。

Objective To evaluate the antitumor efficacy and adverse reaction of erlotinib for recurrence/progression in patients with non-small cell lung cancer （NSCLC） with brain metastases after radiotherapy. Methods The clinical data of 37 NSCLC patients with previously irradiated and recurrent/progressive brain metastases was analyzed retrospectively. They were treated orally with erlotinib at 150 mg· d^-1 . The efficacy and adverse reaction were evaluated after 8 weeks＇ treatment. Results Thirteen patients had EGFR gene exon 19/21 mutations and 24 patients with unknown EGFR mutational status. The overall disease control rate （DCR） for all patients with intracranial brain metastases was 56.7%, including 5 patients （ 13.5% ） with partial response （PR） and 16 patients （43.3%） under stable disease （SD） condition. The PR and SD in the mutational group were 3 and 8 cases, those were 2 and 8 cases in the unspecified mutational group, respectively. As for systemic disease, DCR was 40.5% including PR in 3 patients （8.1%）, SD in 12 ones （32.4%） ;The PR and SD in the mutational group were 2 and 7 cases, and which were 1 case and 5 cases in the unspecified mutational group, respectively. Erlotinib showed significantly more effective in the mutational group than that in the unspecified mutational group （ P〈0.05 ）. The major adverse reactions were grade 1/2 fatigue 64.9% , skin rash and diarrhea with 43.2% and 21.6% , respectively. The incidence of rash was conspicuously higher in mutational group than that in the unspecified mutational group （ P〈0.05 ）. Conclusion Erlotinib is effective and safe on treating NSCLC patients with previously irradiated, recurrent/progressive brain metastases, especially for those with EGFR mutations, which should be considered as a new therapeutic option.