非小细胞肺癌脑转移厄洛替尼和吉非替尼治疗临床比较

Clinical comparison of erlotinib and gefitinib in non-small cell lung cancer with brain metastases

目的比较和评价厄洛替尼和吉非替尼靶向治疗非小细胞肺癌脑转移的疗效。方法回顾性分析2009-01-01-2012-11-25广州医科大学附属第一医院81例晚期NSCLC初诊有脑转移患者和111例晚期NSCLC初诊无脑转移患者,192例患者均为肺腺癌合并EGFR基因突变,分为吉非替尼和厄洛替尼治疗组,生存分析采用Kaplan-Meier法统计,组间生存率比较采用Log-rank检验。结果初诊有脑转移患者颅内病灶,客观有效率为45.68%(37/81),疾病控制率为90.12%(73/81)。吉非替尼、厄洛替尼治疗的无进展生存期(progression-free survival,PFS)分别为9.5和9.0个月,P=0.344;不同EGFR突变类型(19外显子序列缺失突变、21外显子突变)PFS比较分别为10.4和8.6个月,P=0.408。初诊无脑转移患者PFS分别为14.0和15.0个月,P=0.369;不同EGFR突变类型的PFS分别为14.0和15.0个月,P=0.408。结论厄洛替尼和吉非替尼一线治疗肺癌EGFR突变脑转移效果无显著性差异。

OBJECTIVE To compare and evaluate the efficacy of erlotinib and gefitinib treatment of brain metastases from advanced non-small cell lung cancer. To observe the relationship of the brain lesions and PFS between TKI types and the EGFR mutations. METHODS A retrospective study was performed on 81 cases advanced NSCLC with EGFR mutation and newly-diagnosed brain metastases and 111 cases advanced NSCLC and EGFR mutation without brain metastases, who were treated in our hospital from January 1th, 2009 to November 25th, 2012. All patients were divided into ge- fitinib or erlotinib treatment groups. Kaplan-Meier method was used to analyze the survival rate, the Log-rank test was used to compared the diffrence between the two groups. RESULTS For patients with newly diagnosed brain metastases, an objective response rate of 45.68% （37/81） and a disease control rate of 90.12%（73/81） were achieved, while those receiving gefitinib or erlotinib treatment had a progression-flee survival （PFS） of 9. 5 or 9.0 months, respectively （P= 0. 344） ,and those with mutation in Exon 19 or Exon 21 of EGFR showed a PFS of 10.4 or 8.6 months,respectively （P= 0. 408）. For patients without newly diagnosed brain metastasis, the PFS were 14 months for gefitinib and 15.0 months for erlotinib （P=0. 369） ,and 14.0 months for Exon 19 mutation and 15.0 months for Exon 21 mutation （P=0. 408）. CONCLUSION It showed no profound significant differences in efficacy between gefitinib and erlotinib as the first line treat- ment for patients with brain metastases from advanced NSCLC and somatic EGFR mutations.