厄洛替尼和吉非替尼用于控制非小细胞肺癌中软脑膜癌病的比较

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2015-4-27 星期一
厄洛替尼和吉非替尼用于控制非小细胞肺癌中软脑膜癌病的比较
Erlotinib Versus Gefitinib for Control of Leptomeningeal Carcinomatosis in Non–Small-Cell Lung Cancer
中文关键词:  软脑膜癌病，吉非替尼，厄洛替尼
英文关键词eptomeningeal carcinomatosis, Gefitinib, Erlotinib.
Lee E, Keam B, Kim DW, Kim TM, Lee SH, Chung DH, Heo DS.
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中文摘要:
      引言：在目前表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）广为应用的情况下，非小细胞肺癌（NSCLC）中的软脑膜癌病（LMC）仍是临床上重要的神经系统并发症。本研究旨在比较吉非替尼和厄洛替尼用于控制NSCLC中LMC的疗效。 方法：回顾性评估首尔国立大学医院2004～2012年间接受EGFR-TKI治疗的25例合并LMC的NSCLC患者病历记录。连续3次脑脊液中未检测到恶性细胞定义为细胞学转阴。对吉非替尼组和厄洛替尼组的细胞学转阴率进行比较。 结果：9例患者存在外显子21点突变，8例患者存在外显子19缺失突变。25例患者中有9例已经应用过EGFR-TKI治疗，并且有一部分在发生LMC后转换为另一种EGFR-TKI。其他16例患者在确诊LMC后开始接受EGFR-TKI治疗。所有患者均接受鞘内化疗（包括甲氨蝶呤），并且其中6例同时接受了全脑放射治疗。接受吉非替尼和厄洛替尼治疗的患者分别为11例和14例。10例存在LMC的患者治疗后细胞学转阴，但其他15例患者未实现脑脊液中的细胞学清除。接受厄洛替尼治疗的LMC患者细胞学转阴率为64.3%（9/14），高于吉非替尼组患者的9.1%（1/11）（P=0.012）。 结论：本研究结果显示，厄洛替尼治疗NSCLC伴发LMC的控制率优于吉非替尼，但仍需要进一步的前瞻性研究。
英文摘要:
      Introduction: Leptomeningeal carcinomatosis (LMC) from non–small-cell lung cancer (NSCLC) is a clinically important neurological complication in the era of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). The purpose of this study was to compare the efficacy of gefitinib and erlotinib for control of LMC in NSCLC. Methods: We retrospectively reviewed medical records of 25 EGFR TKI–treated NSCLC patients with LMC between 2004 and 2012 at Seoul National University Hospital. Cytologic negative conversion was defined as absence of malignant cells in the cerebrospinal fluid three times in succession. Cytologic conversion rates were compared between the gefitinib arm and the erlotinib arm. Results: Nine patients had exon 21 point mutations and eight patients had exon 19 deletional mutations. Nine of 25 patients had already used EGFR TKIs and switched to another EGFR TKI after LMC occurrence. The other 16 patients received EGFR TKIs after LMC diagnoses. All the patients received intrathecal chemotherapy, including methotrexate, and six of them were treated with combined whole-brain radiotherapy. Gefitinib and erlotinib were administered to 11 and 14 patients, respectively. Ten patients had LMC controlled with cytologic negative conversion, whereas in 15 patients, cytological clearance of the cerebrospinal fluid could not be achieved. Patients treated with erlotinib showed better cytologic conversion rate of LMC than those with gefitinib (64.3% [9 of 14] in the erlotinib arm versus 9.1% [1 of 11] in the gefitinib arm; p = 0.012). Conclusion: This study suggested that erlotinib had better control rate for LMC in NSCLC than gefitinib. Further prospective study is warranted.