The Role of Radiotherapy in Epidermal Growth Factor Receptor Mutation-positive Patients with Oligoprogression: A Matched-cohort Analysis.

Autor: Chan OSH; Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China. Electronic address: chansh2@ha.org.hk., Lee VHF; Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China., Mok TSK; Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, China., Mo F; Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, China., Chang ATY; Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China; Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China., Yeung RMW; Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
Jazyk: angličtina
Zdroj: Clinical oncology (Royal College of Radiologists (Great Britain)) [Clin Oncol (R Coll Radiol)] 2017 Sep; Vol. 29 (9), pp. 568-575. Date of Electronic Publication: 2017 May 09.
DOI: 10.1016/j.clon.2017.04.035
Abstrakt: Aims: Almost all patients with epidermal growth factor receptor (EGFR) mutations will develop resistance to first-line EGFR tyrosine kinase inhibitors (TKIs). The management of oligoprogression on EGFR TKI is controversial. Irradiating progressing tumours may potentially eradicate the resistant clone and allow continuation of EGFR TKI, but the clinical data remain sparse. We aimed to assess the effect of radiotherapy on survival outcomes in patients with oligoprogression in a matched-cohort study.
Materials and Methods: This was a retrospective matched-cohort study comparing patients with EGFR mutation-positive stage IV non-small cell lung cancer receiving radiotherapy versus chemotherapy for progression. Patients in the radiotherapy group received radiotherapy (mainly stereotactic ablative radiotherapy) for oligoprogression, whereas the chemotherapy group received only systemic chemotherapy upon progression. Key prognostic factors including gender, age, performance status, time to first progression and mutation subtypes were matched.
Results: Twenty-five patients with oligoprogression (radiotherapy group) were identified, and a matched chemotherapy group with the same number of patients was generated. The median duration of follow-up was 24.3 and 34 months for the radiotherapy and chemotherapy groups, respectively. The median overall survival of the radiotherapy group was significantly longer than the chemotherapy group, 28.2 versus 14.7 months (P = 0.026). The median progression-free survival (PFS) was 7.0 and 4.1 months after radiotherapy and chemotherapy, respectively (P = 0.0017). The use of radiotherapy was an independent predictive factor of overall survival and PFS in multivariate analysis. Only one patient had ≥grade 3 toxicity after radiotherapy. The frequency of secondary T790M mutation and subsequent Osimertinib exposure were similar in both groups.
Conclusion: Radiotherapy may effectively extend EGFR TKI therapy for patients with oligoprogression on TKI. Improved PFS and overall survival were observed, although potential biases should not be overlooked. Further randomised studies are warranted.
(Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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