Background: Lung cancer is frequently a disease of elderly patients. However, these patients are often treated less actively owing to a higher comorbidity rate and poor performance status. The efficacy of different treatments in elderly patients with epidermal growth factor receptor (EGFR)-mutated lung cancer is still unknown.
Materials and methods: We retrospectively reviewed the records of our pulmonary adenocarcinoma patients treated between 2010 and 2013. Data on patient age, type of tumor EGFR mutation, response to first-line EGFR-tyrosine kinase inhibitor (TKI) treatment, type of salvage chemotherapy, and efficacy of EGFR-TKI and salvage chemotherapy were collected.
Results: In all, 473 of 1,230 stage IV adenocarcinoma patients had an EGFR mutation, and 330 of them received first-line TKI treatment. Of the 330 patients, 160 were ≥70 years old (elderly group) and 170 were <70 years old (younger group). The response rate and progression-free survival (PFS) with first-line TKI treatment were not significantly different. The elderly group had shorter median survival. A total of 107 patients received salvage chemotherapy after first-line EGFR-TKI treatment: 45 in the elderly group and 62 in the younger group. Their response rate and PFS were not significantly different; however, the younger group had longer median survival. Additional subgroup analysis showed that younger patients who received platinum-based chemotherapy or combination chemotherapy had better median survival than did the elderly patients. The PFS was longer among younger patients receiving a platinum-based regimen than that among the elderly patients.
Conclusion: Elderly patients with disease progression after first-line EGFR-TKI treatment can receive chemotherapy and have a response rate similar to that of younger patients.
Implications for practice: The aim of the present study was to investigate the efficacy of first-line epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatment in elderly patients and the outcomes of subsequent salvage chemotherapy after disease progression. The most important finding was that elderly patients with disease progression after first-line EGFR-TKI treatment can receive salvage chemotherapy and have a response rate similar to that of younger patients who received salvage chemotherapy.
摘要
背景. 肺癌是老年患者中的常见疾病。然而,这些患者常因共病率较高以及体能状态较差而得不到更积极的治疗。目前还未明确不同治疗在表皮生长因子受体(EGFR)突变肺癌老年患者中的有效性。
材料与方法. 我们对2010年至2013年在本中心接受治疗的肺腺癌患者资料进行回顾性评价。收集数据包括患者年龄、肿瘤EGFR突变类型、一线EGFR酪氨酸激酶抑制剂(TKI)治疗反应、挽救性化疗类型,以及EGFR-TKI和挽救性化疗的有效性。
结果. 总体而言,1 230例IV期腺癌患者中有473例携带EGFR突变,其中330例接受了一线TKI治疗。330例患者中,160例≥ 70岁(老年组),170例˂ 70岁(较年轻组)。两组间一线TKI治疗的缓解率和无进展生存(PFS)的差异无统计学意义。老年组中位生存期更短。共107例患者在一线EGFR-TKI治疗后接受了挽救性化疗,其中老年组45例,较年轻组62例。两组的缓解率和PFS方面的差异均无统计学意义;但较年轻组中位生存期更长。另外的亚组分析显示,曾接受过以铂类为基础的化疗或联合化疗的年轻患者生存期长于老年患者。正在接受以铂类为基础的方案的较年轻患者PFS长于老年患者。
结论. 在一线EGFR-TKI治疗后疾病进展的老年患者可以接受化疗,且缓解率与年轻患者相似。The Oncologist 2015;20:758–766
Keywords: Adenocarcinoma; Elderly; Epidermal growth factor receptor; Tyrosine kinase inhibitors.
©AlphaMed Press.