皮疹和支气管肺泡组织学与患者临床受益吉非替尼治疗以前治疗的先进或转移性非小细胞肺癌。

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杜德克AZ, Kmak KL Koopmeiners J, Keshtgarpour M

皮疹和支气管肺泡组织学与患者临床受益吉非替尼治疗以前治疗的先进或转移性非小细胞肺癌。

肺癌。2006年1月,51 (1):89 - 96。Epub 2005年11月14日。

PubMed ID
16290256 (在PubMed
]
文摘

背景:只有15%的非小细胞肺癌(NSCLC)患者治疗口腔表皮生长因子酪氨酸激酶抑制剂吉非替尼,作为二线治疗的客观反应。百分之五十会提高肺癌相关症状。这将是识别患者将受益的关键临床从这个疗法即使没有客观的反应出现在成像研究。我们进行了回顾性分析76名患者接受吉非替尼作为一个治疗之前治疗转移性NSCLC明尼苏达大学综合癌症中心为了描述特征的病人可能会从吉非替尼治疗中获得益处。方法:所有患者接受吉非替尼治疗明尼苏达大学从2001年9月到2004年1月进入研究。生存率较和Cox比例风险回归是用来评估以前的治疗行数的影响,组织学亚型,性能状况、性别、疾病早期诊断阶段,出现皮疹的疾病进展时间和总生存期(OS)。确切概率法和多元逻辑回归来评估这些协变量的影响对疾病的反应。结果:七十六例患者进入研究,平均年龄为60岁(范围37 - 82)。有37个女性和39岁男性患者;47名患者腺癌,22鳞状和7有其他非小细胞肺癌组织学。 Six patients had no prior therapy, 23 had one, 32 had two, 8 had three, and 7 had four prior therapies for lung cancer. Fifty-six were current smokers. Median time to disease progression was 3 months (95% CI: 3.0, 6.0). There was no difference in time to disease progression whether patients had one or more prior therapies. Patients with brain metastases (26 patients) benefited from gefitinib therapy at least equally well as those without brain metastatic disease. Patients with adenocarcinoma histology with bronchoalveolar features had superior median time to progression versus other lung cancer histology (14 months versus 3 months, p=0.076), which translated into survival advantage in this group >24 months (95% CI: 0.76, 24+) versus 6.6 months (p=0.0096). Patients with EGFR positive tumors had median survival of 10.2 months (95% CI: 1.45, 16.94) versus 3.7 months (95% CI: 2.66, 4.74) with EGFR negative tumors. Patients who developed any degree of skin rash had prolonged time to disease progression with median of 6 months (95% CI: 2.56, 15.5) versus patients without skin rash median 3 months (95% CI: 1.43, 2.83) (p=0.023). This last factor was the best predictor of improved time to disease progression in multiple regression analysis (p=0.0405). CONCLUSION: A subgroup of patients with NSCLC will benefit from gefitinib therapy. Objective responses will likely be seen in half the patients with mutation of internal domain of EGFR; however, a larger group of patients will also enjoy prolonged disease stabilization and clinical benefit. We suggest that adenocarcinoma with bronchoalveolar features and the presence of skin rash may be used as predictors of gefitinib benefit.

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