{"title":"EGFR- tkis联合化疗与化疗或EGFR- tkis单独治疗EGFR突变晚期NSCLC患者","authors":"Miaomiao Wen, Jinghua Xia, Ying Sun, Xuejiao Wang, Xianghui Fu, Yanning Zhang, Zhipei Zhang, Yongan Zhou, Xiaofei Li","doi":"10.2147/BTT.S169305","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Both epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and chemotherapy are widely applied for the treatment of advanced non-small-cell lung cancer (NSCLC) with EGFR mutations, and the combination of EGFR-TKIs and chemotherapy has been used for advanced NSCLC patients; however, little is known about the efficacy of the direct comparison among them.</p><p><strong>Patients and methods: </strong>The demographic and clinical characteristics of 92 patients harboring advanced NSCLC with EGFR mutation were retrospectively reviewed. We evaluated the effects of EGFR-TKIs, chemotherapy, and EGFR-TKIs plus chemotherapy on advanced NSCLC patients with EGFR mutations, and the efficacy of combination of chemotherapy and EGFR-TKIs vs chemotherapy or EGFR-TKIs alone in advanced NSCLC patients was evaluated.</p><p><strong>Results: </strong>The statistical results showed that the intercalated combination of EGFR-TKIs plus chemotherapy significantly improved progression-free survival (PFS; HR, 1.76; 95% CI 1.03-3.01; <i>P</i>=0.036; median, 20.5 vs 16 months) compared with EGFR-TKI monotherapy, but no difference in overall survival (OS) was observed between these two groups (HR, 1.52; 95% CI 0.81-2.83; <i>P</i>=0.19; median, 36 vs 29 months). However, patients who received the combination of chemotherapy and EGFR-TKIs had longer PFS (HR, 2.78; 95% CI 1.57-4.93; <i>P</i><0.0001; median, 20.5 vs 12 months) as well as OS (HR, 2.86; 95% CI 1.56-5.27; <i>P</i>=0.001; median, 36 vs 18 months) than those who received chemotherapy alone. Toxicities were mild among the three treatment groups. Rash and diarrhea were common adverse events (AEs) in the EGFR-TKI group, anemia and nausea in the chemotherapy group, and anemia and diarrhea in the combination group.</p><p><strong>Conclusion: </strong>This study demonstrated that the combination of chemotherapy with EGFR-TKIs as first-line treatment has a significant effect on PFS in patients with advanced NSCLC whose tumors harbor activating EGFR mutations. The combination treatment had more toxicity, but was clinically manageable.</p>","PeriodicalId":9025,"journal":{"name":"Biologics : Targets & Therapy","volume":"12 ","pages":"183-190"},"PeriodicalIF":5.3000,"publicationDate":"2018-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/BTT.S169305","citationCount":"19","resultStr":"{\"title\":\"Combination of EGFR-TKIs with chemotherapy versus chemotherapy or EGFR-TKIs alone in advanced NSCLC patients with EGFR mutation.\",\"authors\":\"Miaomiao Wen, Jinghua Xia, Ying Sun, Xuejiao Wang, Xianghui Fu, Yanning Zhang, Zhipei Zhang, Yongan Zhou, Xiaofei Li\",\"doi\":\"10.2147/BTT.S169305\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Both epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and chemotherapy are widely applied for the treatment of advanced non-small-cell lung cancer (NSCLC) with EGFR mutations, and the combination of EGFR-TKIs and chemotherapy has been used for advanced NSCLC patients; however, little is known about the efficacy of the direct comparison among them.</p><p><strong>Patients and methods: </strong>The demographic and clinical characteristics of 92 patients harboring advanced NSCLC with EGFR mutation were retrospectively reviewed. We evaluated the effects of EGFR-TKIs, chemotherapy, and EGFR-TKIs plus chemotherapy on advanced NSCLC patients with EGFR mutations, and the efficacy of combination of chemotherapy and EGFR-TKIs vs chemotherapy or EGFR-TKIs alone in advanced NSCLC patients was evaluated.</p><p><strong>Results: </strong>The statistical results showed that the intercalated combination of EGFR-TKIs plus chemotherapy significantly improved progression-free survival (PFS; HR, 1.76; 95% CI 1.03-3.01; <i>P</i>=0.036; median, 20.5 vs 16 months) compared with EGFR-TKI monotherapy, but no difference in overall survival (OS) was observed between these two groups (HR, 1.52; 95% CI 0.81-2.83; <i>P</i>=0.19; median, 36 vs 29 months). However, patients who received the combination of chemotherapy and EGFR-TKIs had longer PFS (HR, 2.78; 95% CI 1.57-4.93; <i>P</i><0.0001; median, 20.5 vs 12 months) as well as OS (HR, 2.86; 95% CI 1.56-5.27; <i>P</i>=0.001; median, 36 vs 18 months) than those who received chemotherapy alone. Toxicities were mild among the three treatment groups. Rash and diarrhea were common adverse events (AEs) in the EGFR-TKI group, anemia and nausea in the chemotherapy group, and anemia and diarrhea in the combination group.</p><p><strong>Conclusion: </strong>This study demonstrated that the combination of chemotherapy with EGFR-TKIs as first-line treatment has a significant effect on PFS in patients with advanced NSCLC whose tumors harbor activating EGFR mutations. The combination treatment had more toxicity, but was clinically manageable.</p>\",\"PeriodicalId\":9025,\"journal\":{\"name\":\"Biologics : Targets & Therapy\",\"volume\":\"12 \",\"pages\":\"183-190\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2018-11-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.2147/BTT.S169305\",\"citationCount\":\"19\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Biologics : Targets & Therapy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2147/BTT.S169305\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2018/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Biologics : Targets & Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/BTT.S169305","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2018/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
引用次数: 19
摘要
目的:表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitors, EGFR- tkis)和化疗均广泛应用于EGFR突变的晚期非小细胞肺癌(non-small-cell lung cancer, NSCLC)的治疗，EGFR- tkis联合化疗已被用于晚期NSCLC患者;然而，人们对它们之间直接比较的效果知之甚少。患者和方法:回顾性分析92例晚期非小细胞肺癌EGFR突变患者的人口学和临床特征。我们评估了EGFR- tkis、化疗和EGFR- tkis联合化疗对EGFR突变的晚期NSCLC患者的影响，并评估了化疗联合EGFR- tkis与化疗或单独EGFR- tkis在晚期NSCLC患者中的疗效。结果:统计学结果显示，EGFR-TKIs插入联合化疗可显著提高无进展生存期(PFS;人力资源,1.76;95% ci 1.03-3.01;P = 0.036;中位数(20.5 vs 16个月)与EGFR-TKI单药治疗相比，但两组的总生存期(OS)无差异(HR, 1.52;95% ci 0.81-2.83;P = 0.19;中位数，36个月vs 29个月)。然而，接受化疗和EGFR-TKIs联合治疗的患者PFS更长(HR, 2.78;95% ci 1.57-4.93;页= 0.001;中位数(36个月vs 18个月)比单独接受化疗的患者。三个治疗组的毒性均较轻。EGFR-TKI组常见不良事件为皮疹和腹泻，化疗组常见贫血和恶心，联合用药组常见贫血和腹泻。结论:本研究表明，化疗联合EGFR- tkis作为一线治疗对肿瘤中含有活化EGFR突变的晚期NSCLC患者的PFS有显著影响。联合治疗毒性更大，但临床可控。
Combination of EGFR-TKIs with chemotherapy versus chemotherapy or EGFR-TKIs alone in advanced NSCLC patients with EGFR mutation.
Purpose: Both epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and chemotherapy are widely applied for the treatment of advanced non-small-cell lung cancer (NSCLC) with EGFR mutations, and the combination of EGFR-TKIs and chemotherapy has been used for advanced NSCLC patients; however, little is known about the efficacy of the direct comparison among them.
Patients and methods: The demographic and clinical characteristics of 92 patients harboring advanced NSCLC with EGFR mutation were retrospectively reviewed. We evaluated the effects of EGFR-TKIs, chemotherapy, and EGFR-TKIs plus chemotherapy on advanced NSCLC patients with EGFR mutations, and the efficacy of combination of chemotherapy and EGFR-TKIs vs chemotherapy or EGFR-TKIs alone in advanced NSCLC patients was evaluated.
Results: The statistical results showed that the intercalated combination of EGFR-TKIs plus chemotherapy significantly improved progression-free survival (PFS; HR, 1.76; 95% CI 1.03-3.01; P=0.036; median, 20.5 vs 16 months) compared with EGFR-TKI monotherapy, but no difference in overall survival (OS) was observed between these two groups (HR, 1.52; 95% CI 0.81-2.83; P=0.19; median, 36 vs 29 months). However, patients who received the combination of chemotherapy and EGFR-TKIs had longer PFS (HR, 2.78; 95% CI 1.57-4.93; P<0.0001; median, 20.5 vs 12 months) as well as OS (HR, 2.86; 95% CI 1.56-5.27; P=0.001; median, 36 vs 18 months) than those who received chemotherapy alone. Toxicities were mild among the three treatment groups. Rash and diarrhea were common adverse events (AEs) in the EGFR-TKI group, anemia and nausea in the chemotherapy group, and anemia and diarrhea in the combination group.
Conclusion: This study demonstrated that the combination of chemotherapy with EGFR-TKIs as first-line treatment has a significant effect on PFS in patients with advanced NSCLC whose tumors harbor activating EGFR mutations. The combination treatment had more toxicity, but was clinically manageable.
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