非小细胞肺癌脑膜转移的个体化治疗分析

Analysis of individualized therapy for leptomeningeal metastasis of non-small cell lung cancer

目的:对非小细胞肺癌(non-small cell lung cancer,NSCLC)脑膜转移(leptomeningeal metastasis,LM)患者的个体化治疗行探索性分析。方法:选择于2018年12月至2020年3月福建省肿瘤医院确诊收治的NSCLC合并LM患者18例,收集患者临床诊治资料及生存随访。结果:18例患者中表皮生长因子受体(epidermal growth factor receptor,EGFR)突变14例,间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)突变1例,ROS原癌基因1(ROS proto-oncogene 1 ROS1)突变1例,野生型2例。合并基因突变的LM患者接受以酪氨酸激酶抑制剂(tyrosine-kinase inhibitor,TKI)为基础的靶向治疗联合,或不联合全身及局部综合治疗;共14例患者接受鞘内注射(intrathecal chemotherapy,ITC)培美曲塞治疗。根据神经肿瘤评估标准(response assessment in neuro-oncology,RANO)进行疗效评价,其中12例患者好转,2例稳定,4例进展。结论:NSCLC合并LM需要个性化综合治疗,对存在基因突变的患者采用TKI靶向治疗仍为基石,鞘内注射培美曲塞可能成为一种治疗选择。

Objective:To conduct an exploratory analysis of individualized treatment of leptomeningeal metastasis(LM)in patients with non-small cell lung cancer(NSCLC).Methods:Eighteen NSCLC patients with LM admitted to Fujian Provincial Cancer Hospital from December 2018 to March 2020 were selected.Clinical and treatment data and survival follow-up of patients with LM were collected.Results:Fourteen patients harbored epidermal growth factor receptor(EGFR)mutations,1 anaplastic lymphoma kinase(ALK)fusion,1 proto-oncogene 1(ROS1)fusion,and 2 wild-type.LM patients with genetic mutations received tyrosine kinase inhibitor(TKI)-based targeted therapy with or without combined systemic and local comprehensive treatment.A total of 14 patients received intrathecal chemotherapy(ITC)with pemetrexed.According to the response assessment in neuro-oncology(RANO),12 of 18 patients were evaluated as responding,2 were stable,and 4 were progressive.Conclusion:Individualized comprehensive treatment can prolong the survival of patients of LM.The targeted therapy of patients harbored genetic mutations is still the cornerstone,and ITC of pemetrexed may become a treatment option.