Efficacy of Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors in Metastatic Non-Small Cell Lung Cancer Patients with Poor Performance Status and Epidermal Growth Factor Receptor Mutations: Findings from the Japanese Lung Cancer Registry Database.

Autor: Okuma Y; Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. Electronic address: yokuma@ncc.go.jp., Shintani Y; Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan., Sekine I; Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan., Shukuya T; Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Takayama K; Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan., Inoue A; Department of Palliative Medicine, Tohoku University School of Medicine, Miyagi, Japan., Okamoto I; Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan., Kiura K; Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan., Yamamoto N; Department of Internal Medicine III, Wakayama Medical University Hospital, Wakayama, Japan., Kawaguchi T; Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan., Miyaoka E; Department of Mathematics, Tokyo University of Science, Tokyo, Japan., Yoshino I; Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan., Date H; Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Jazyk: angličtina
Zdroj: Clinical lung cancer [Clin Lung Cancer] 2024 Jun; Vol. 25 (4), pp. 336-346.e2. Date of Electronic Publication: 2024 Feb 02.
DOI: 10.1016/j.cllc.2024.01.005
Abstrakt: Background: In advanced non-small cell lung cancer (NSCLC) patients harboring epidermal growth factor receptor (EGFR) mutations, those with impaired performance status (PS) treated with EGFR-tyrosine kinase inhibitors (TKIs) have demonstrated comparable activities to good-PS patients. Due to the limited sample size and inclusion of older adult patients with good PS, these findings may not accurately depict the efficacy of EGFR-TKI in poor-PS patients. We investigated the benefit of EGFR-TKIs in this population and identified relevant prognostic factors.
Patients and Methods: This nationwide prospective registry study included 9872 patients with local or advanced NSCLC. Outcomes were compared between poor- and good-PS patients treated with EGFR-mutated lung cancer therapies.
Results: Of 9872 NSCLC patients, 1965 (19.9%) had EGFR mutations, with 1846 (93.9%) presenting common EGFR mutations. Poor PS (PS score ≥ 3) was noted in 171 patients (8.7%) and identified as an independent prognostic factor; those with poor PS had a significantly lower 1-year survival rate. The median overall survival (OS) for EGFR-TKI-treated good-PS patients was 31.5 (95% confidence interval, 29.6-33.4) months. Among poor-PS patients with EGFR mutations, 135 (78.9%) of whom were treated with EGFR-TKI had an OS of 15.5 (12.7-18.3) months, while those receiving only supportive care had an OS of 2.5 (1.4-3.6) months (P < .001). Hypoalbuminemia (< 3.5 g/dL), liver metastasis, and uncommon EGFR mutations were associated with poor prognosis.
Conclusion: Poor PS at diagnosis was rare and associated with limited EGFR-TKI efficacy and a dismal prognosis. Liver metastasis and hypoalbuminemia may reduce EGFR-TKI efficacy in these patients.
Competing Interests: Disclosure The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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