埃克替尼治疗非小细胞肺癌脑转移的回顾性研究

A retrospective study of icotinib for patients with brain metastases from non-small cell lung cancer

目的探讨埃克替尼治疗非小细胞肺癌(NSCLC)脑转移的疗效及安全性。方法回顾性分析31例采用埃克替尼治疗的NSCLC脑转移患者的临床资料。所有患者均口服埃克替尼125mg,每天3次,直至疾病进展或出现不可耐受的不良反应,其中25例患者接受脑部放疗。结果 31例患者颅内病灶的有效率(RR)和疾病控制率(DCR)分别为25.8%和83.9%,全身病灶的RR和DCR分别为38.7%和87.1%。接受埃克替尼联合脑部放疗的患者在RR上优于接受埃克替尼单药治疗者,但差异无统计学意义(P>0.05)。RR和DCR与年龄、性别、病理类型、PS评分、脑转移数目、埃克替尼治疗情况、脑部放疗及表皮生长因子受体(EGFR)突变状况均无关。全组中位无进展生存时间(PFS)为6.5个月(95%CI:4.787～8.213个月),其中EGFR突变型为10.1个月。PFS与EGFR基因突变状况有关,而与其他临床病理特征无关。主要不良反应为皮疹、皮肤干燥和腹泻,以1～2级为主。结论埃克替尼对NSCLC脑转移有一定疗效,且不良反应可耐受,值得进一步研究。

Objective To evaluate the clinical efficacy and the side effects of icotinib in treatment of brain metastases from non-small cell lung cancer （NSCLC）. Methods Thirty-one cases of NSCLC with brain metastases who received icotinib were re- viewed. All of them were treated with icotinib（ 125mg, 3 times a day） until disease progression or unacceptable toxicities, and 25 pa- tients of them received brain radiotherapy. Results In terms of intracranial lesions,the response rate（RR） and disease control rate （DCR） were 25.8% and 83.9%. As for systemic disease, RR and DCR were 38.7% and 87. 1%. Patients who received brain radia- tion had better RR than those without brain radiation（ P 〉 0. 05 ）. RR and DCR were not related to age, gender, pathological types, PS score, brain metastases, icotinib administration, brain radiotherapy and epidermal growth factor receptor（EFGR） mutation. The medi- an prugression-free survival（PFS） was 6. 5 months （95% C1：4. 787-8. 213 months）, while it in EGFR mutation patients was 10. 1 months. PFS was related to EGFR mutation status, and not to other clinical pathological features. The common side effects of icotinib were rash,dry skin and diarrhea, mainly in grade 1-2. Conclusion Icotinib may be effective on brain metastases in NSCLC patients, and the toxicities are tolerable, which worth further study.