厄洛替尼治疗非小细胞肺癌脑转移的回顾性分析

Erlotinib for Patients with Brain Metastasis from Non-small-cell Lung Cancer: A Retrospective Study

背景与目的:非小细胞肺癌(non-small-cell lung cancer,NSCLC)脑转移预后差,缺乏有效的治疗方法。厄洛替尼是小分子EGFR酪氨酸激酶抑制剂,广泛应用于晚期NSCLC患者,可延长患者的中位无进展生存及总生存期,经选择患者获益更为明显。目前厄洛替尼也逐渐用于NSCLC脑转移的治疗。本文通过分析厄洛替尼治疗NSCLC脑转移的疗效及安全性,探讨NSCLC脑转移的靶向治疗。方法:回顾性分析中山大学肿瘤防治中心2006年至2011年间收治的53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直至疾病进展、死亡或不良反应不可耐受,每2～3月评估疗效。结果:53例患者均可评价疗效。厄洛替尼对脑转移灶客观缓解率和疾病控制率分别为35.8%和81.1%,其中完全缓解(complete response,CR)3例,部分缓解(partialresponse,PR)16例,稳定(stable disease,SD)24例。全身病灶的客观缓解率和疾病控制率分别为35.8%和64.2%,其中CR 1例,PR 18例,SD 15例。脑转移灶的中位进展时间为7.3个月,全组中位无进展生存时间及中位总生存时间分别为5.6个月和15.9个月。1年、2年生存率分别为37.7%和11.3%。多因素分析显示,年龄、PS评分及EGFR状态为影响生存的因素。最常见的不良反应为皮疹和腹泻,发生率分别为75.5%和37.7%。结论:厄洛替尼对NSCLC脑转移有一定疗效,且毒性可以耐受。

BACKGROUND OBJECTIVE： The outcomes of brain metastases from non-small-cell lung cancer（NSCLC） are very poor without effective treatment options.Erlotinib,a tyrosine kinase inhibitor（TKI） of epidermal growth factor receptor（EGFR） has been widely used in treatment for NSCLC and has brought the survival benefits to patients,especially in selected patients.At present,erlotinib has also been gradually used in patients with brain metastases（BM） from NSCLC.The aim of this study was to evaluate the clinical efficacy and the side effects of erlotinib in treatment of BM from NSCLC.METHODS： We retrospectively reviewed 53 patients with BM from NSCLC who received erlotinib between 2006 and 2011 at Sun Yat-Sen University Cancer Center.All of them were treated with erlotinib（150mg,daily） until disease progression,unacceptable toxicity or disease progression.Tumor responses were evaluated every 2 or 3 months.RESULTS： All 53 patients were available for evaluation of responses.The objective response rate（ORR） and the disease control rate（DCR） of BM were 35.8% and 81.1%,respectively,including 3 cases with CR,16 cases with PR and 24 cases with SD.Taking into account of all the lesions,the overall ORR and DCR were 35.8% and 64.2% respectively,including 1 case with CR,18 cases with PR and 15 cases with SD.The median time to progression of BM was 7.3 months.The median progression-free survival（PFS） and median overall survival（OS） were 5.6 months and 15.9 months,respectively.The 1-year and 2-year survival rates were 37.7% and 11.3%,respectively.The multivariate analysis showed that age,performance score,and EGFR mutation status were independently associated with overall survival.The most common side effects of erlotinib were rash and diarrhea,observed in 75.5%（40/53） and 37.7%（20/53） of the cases,respectively.CONCLUSON： Erlotinib is an effective therapy for patients with BM from NSCLC with tolerable side effects.