期刊
TRANSLATIONAL LUNG CANCER RESEARCH
卷 10, 期 9, 页码 3782-+出版社
AME PUBL CO
DOI: 10.21037/tlcr-21-681
关键词
Non-small cell lung cancer (NSCLC); EGFR-TKIs; antiangiogenic therapy; immunotherapy; resistance
资金
- Shanghai Municipal Health Commission [20164Y0269]
- Cancer Research Funding of CSCO-Hausen [Y-HS2019/2-072]
- National Natural Science Foundation of China [81874036, 82072568]
- Science and Technology Commission of Shanghai Municipality [19411971100]
- Shanghai Shenkang Hospital Development Center [SHDC12020110]
After EGFR-TKI therapy failure, chemo-immunotherapy combinations achieved a higher objective response rate compared to chemo-antiangiogenesis combinations, but no significant difference was found in disease control rate and progression-free survival. For patients with EGFR T790M mutations, chemo-antiangiogenesis combinations may be the preferred therapeutic option, and platelet count could be a potential prognostic factor for patients after EGFR-TKI therapy failure.
Background: Despite the potent efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) in the treatment of EGFR-mutant non-small cell lung cancer (NSCLC) patients, drug resistance inevitably ensues, and there remains a paucity of treatment options in clinical practice. Methods: We identified patients with EGFR-mutant advanced NSCLC presenting to Shanghai Pulmonary Hospital and Shanghai Chest Hospital between January 2015 and December 2020 treated with chemoantiangiogenesis or chemo-immunotherapy combinations after EGFR-TKI resistance. Patient information was collected, and the objective response rate (ORR), disease control rate (DCR), and progression-free survival (PFS) were assessed. Results: A total of 144 patients who met our inclusion criteria were enrolled. Chemo-immunotherapy combinations achieved a higher objective response rate (ORR) compared with chemo-antiangiogenesis combinations (29.5% vs. 13.0%, P=0.018). The DCR was similar between the two groups (93.0% vs. 88.6%, P=0.585), as was the median PFS (7.59 vs. 6.90 months, P=0.552). In the subgroup analyses, patients who developed secondary T790M mutations after EGFR-TKI treatment were less likely to benefit from chemoimmunotherapy combinations than their T790M-negative counterparts (3.42 vs. 7.63 months, P=0.028). For patients who received chemo-antiangiogenesis combinations after TKI resistance, no significant difference was observed in the median PFS between T790M-positive and T790M-negative patients (median PFS: 5.33 vs. 7.46 months, P=0.202). Additionally, multivariate analysis showed that an elevated platelet count was independently associated with a worse PFS for both groups. Conclusions: The efficacy of chemo-immunotherapy combinations was comparable to chemoantiangiogenesis combinations after failure of EGFR-TKI therapy. For patients harboring EGFR T790M mutations, chemo-antiangiogenesis combinations may be the preferred therapeutic option. In addition, platelet count could be a potential prognostic factor for patients after failure of EGFR-TKI therapy. Further research should be conducted on larger populations and in a prospective setting.
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