Central nervous system progression in advanced non–small cell lung cancer patients with EGFR mutations in response to first-line treatment with two EGFR-TKIs, gefitinib and erlotinib: a comparative study

BMC Cancer

Research Article

Ge Wang¹  Zhi-Min Zhang¹  Hao He¹  Xiao He¹  Zhen-Zhou Yang¹  Yan Wu¹  Meng-Xia Li¹  Bao-Hua Lan¹  Yu-Xi Zhu²  Zhi-Hua Ruan³  Hua-Liang Xiao⁴  Rong-Qing Li⁵  Guo-Dong Liu⁶  Bo Zhu⁷ 

[1] Cancer Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, 10 Changjiang Zhilu, Daping Yuzhong District, 400042, Chongqing, People’s Republic of China;Department of Oncology, First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, People’s Republic of China;Department of Oncology, Southwest Hospital, Third Military Medical University, 400037, Chongqing, People’s Republic of China;Department of Pathology, Research Institute of Surgery, Daping Hospital, Third Military Medical University, 400042, Chongqing, People’s Republic of China;Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, 650032, Kunming, Yunnan, People’s Republic of China;Eighth Department, Research Institute of Surgery, Daping Hospital, Third Military Medical University, 400042, Chongqing, People’s Republic of China;Institute of Cancer, Xinqiao Hospital, Third Military Medical University, 400037, Chongqing, People’s Republic of China;

关键词: EGFR-TKIs;    Erlotinib;    Gefitinib;    NSCLC;    EGFR mutation;   

DOI  :  10.1186/s12885-017-3165-0

 received in 2016-01-25, accepted in 2017-03-02,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCentral nervous system (CNS) brain metastasis of advanced non-small cell lung cancer (NSCLC) patients confers a worse quality of life and prognosis. The efficacy comparison of two first-generation epidermal growth factor receptor (EGFR) inhibitors erlotinib or gefitinib as first-line treatment for CNS metastasis NSCLC patients with EGFR-sensitizing mutations is yet to be elucidated.MethodsA retrospective analysis was done on cerebral metastasis rate after erlotinib or gefitinib as first-line treatment for advanced NSCLC patients with EGFR-sensitizing mutations. Time to neurological progression (nTTP) and median progression-free survival (mPFS) were calculated.ResultsThe study involved 279 patients (erlotinib group: 108, gefitinib group: 171). After a median follow-up of 22 months, 27 patients (25%) in the erlotinib group and 60 patients (35.1%) in the gefitinib group showed CNS progression. The HR of CNS progression for erlotinib versus gefitinib was 0.695 [95% confidence interval (CI), 0.406–1.190], suggesting a risk reduction of 30.5% although not achieving statistical significance. The 6-, 12- and 18-month cumulative CNS progression rates were 0.9, 3.7 and 12% for erlotinib compared with corresponding rates of 5.8, 9.4 and 17% for gefitinib (P = 0.181). However, for those patients with preexisting brain metastases prior to EGFR-TKI treatment, erlotinib as first line treatment significantly extended the median nTTP in comparison to gefitinib (30 months vs 15.8 months, p = 0.024).ConclusionsOur data show that nTTP can be effectively extended in preexisting brain metastases patients with EGFR-sensitizing mutations initially treated with erlotinib compared with gefitinib. If confirmed, our results indicate that erlotinib may play an important role in controlling CNS progression from EGFR mutation-positive NSCLC.

【 授权许可】

CC BY   
© The Author(s). 2017