Primary tumor consolidative therapy improves the outcomes of patients with advanced EGFR -mutant lung adenocarcinoma treated with first-line osimertinib.

Autor:	Wu JJ; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.; Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan., Tseng JS; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan.; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Zheng ZR; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.; Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan., Chu CH; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.; Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan., Chen KC; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.; Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan., Lin MW; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan., Huang YH; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.; College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan., Hsu KH; Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan., Yang TY; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan., Yu SL; Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan.; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan., Chen JS; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan.; Department of Surgical Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan., Ho CC; Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan., Chang GC; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.; Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Chien-kuo North Road, Taichung 402, Taiwan.; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan.
Jazyk:	angličtina
Zdroj:	Therapeutic advances in medical oncology [Ther Adv Med Oncol] 2024 Jan 03; Vol. 16, pp. 17588359231220606. Date of Electronic Publication: 2024 Jan 03 (Print Publication: 2024).
DOI:	10.1177/17588359231220606
Abstrakt:	Background: Patients with advanced epidermal growth factor receptor ( EGFR )-mutant lung adenocarcinoma (LAD) inevitably experience drug resistance following treatment with EGFR-tyrosine kinase inhibitors (TKIs). Objectives: We aimed to analyze the effect of primary tumor consolidative therapy (PTCT) on patients treated with first-line osimertinib. Design and Methods: This retrospective cohort study was conducted in patients with advanced stage III or stage IV LAD with EGFR-sensitizing mutations (exon 19 deletion or L858R mutation) with disease control after first-line osimertinib. A curative dose of primary tumor radiotherapy or primary tumor resection was classified as PTCT. We compared the progression-free survival (PFS) and overall survival (OS) of patients with and without PTCT. Results: This study included 106 patients with a median age of 61.0 years, and of those, 42% were male and 73.6% were never-smokers. Exon 19 deletion was observed in 67.9%, 30.2% had a programmed cell death ligand 1 (PD-L1) tumor proportion score <1%, 33.0% had brain metastasis, and 40.6% had oligometastasis. In all, 53 (50%) patients underwent PTCT. Patients who underwent PTCT demonstrated significantly better PFS [30.3 (95% confidence interval (CI), 24.1-36.4) versus 18.2 (95% CI, 16.1-20.2) months; p = 0.005] and OS [not reached versus 36.7 (95% CI, 32.5-40.9) months; p = 0.005] than patients who did not. A multivariate analysis showed that PTCT was an independent factor associated with better PFS [hazard ratio (HR), 0.22; 95% CI, 0.10-0.49; p < 0.001] and OS [HR, 0.10; 95% CI, 0.01-0.82; p = 0.032]. The PFS benefits of PTCT were consistent across subgroups, and the HR tended to be lower in patients aged <65 years, males, smokers, stage IVB disease, L858R, PD-L1 expression ⩾1%, non-oligometastasis, and brain metastasis. Conclusion: Of the patients with advanced EGFR -mutant LAD, those who underwent PTCT had a significantly better survival outcome than those who did not. The survival benefits were consistent across different subgroups. Competing Interests: The authors declare that there is no conflict of interest. (© The Author(s), 2024.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu