egfr突变的非小细胞肺癌患者在一线奥西替尼停药后再用另一种TKI挑战EGFR-TKI的真实世界研究:Reiwa研究的亚群分析

IF 2.3 3区 医学 Q3 ONCOLOGY Thoracic Cancer Pub Date : 2025-01-01 Epub Date: 2024-12-07 DOI:10.1111/1759-7714.15507
Kei Sonehara, Kazunari Tateishi, Kiyotaka Yoh, Kazuhiro Usui, Yukio Hosomi, Kazuma Kishi, Go Naka, Kageaki Watanabe, Shu Tamano, Kohei Uemura, Hideo Kunitoh
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引用次数: 0

摘要

简介:一线奥希替尼被广泛用于治疗表皮生长因子受体(EGFR)突变的非小细胞肺癌(NSCLC)患者。在临床实践中,由于耐药或毒性,一线TKI停药后,经常使用另一种egfr -酪氨酸激酶抑制剂(TKI)进行再挑战治疗;然而,一线奥西替尼治疗后EGFR-TKI再挑战的疗效和毒性尚未得到充分的研究。本研究旨在检验EGFR-TKI再挑战另一种TKI的有效性和安全性。方法:这项多中心前瞻性观察性研究纳入了2018年9月至2020年8月期间接受一线奥西替尼和另一种EGFR-TKI作为二线或三线治疗的egfr突变NSCLC患者。结果:53例患者在二线(n = 38, 71.7%)或三线(n = 15, 28.3%)的情况下再次接受了另一种EGFR-TKI治疗。一线奥希替尼停药的主要原因是32例(60.4%,17例肺炎)的毒性和20例(37.7%)的疾病进展。最常见的再挑战EGFR-TKI是阿法替尼(n = 24, 45.3%),其次是吉非替尼(n = 16, 30.2%)和厄洛替尼(n = 8, 15.1%)。实际治疗失败时间(rwTTF)为7.3个月。毒性停药组和进行性疾病停药组的rwTTF分别为9.3个月和5.1个月,(HR 1.61, p = 0.119)。9名患者(17.0%)因毒性而停止了EGFR-TKI再挑战,但没有患者发生肺炎。结论:EGFR-TKI再挑战另一种TKI在egfr突变的NSCLC患者中具有良好的耐受性。因此,它可能是一线奥希替尼失败后的一个有用的治疗选择,特别是在奥希替尼因毒性停药后。
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Real-World Study of EGFR-TKI Rechallenge With Another TKI After First-Line Osimertinib Discontinuation in Patients With EGFR-Mutated Non-Small Cell Lung Cancer: A Subset Analysis of the Reiwa Study.

Introduction: First-line osimertinib is widely used to treat patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancers (NSCLC). In clinical practice, rechallenge therapy with another EGFR-tyrosine kinase inhibitor (TKI) is often performed after first-line TKI discontinuation owing to resistance or toxicity; however, the efficacy and toxicity of EGFR-TKI rechallenge after first-line osimertinib have not been adequately investigated. This study aimed to examine the efficacy and safety of EGFR-TKI rechallenge with another TKI.

Methods: This multicenter prospective observational study enrolled patients with EGFR-mutated NSCLC who received first-line osimertinib and another EGFR-TKI as second- or third-line treatment between September 2018 and August 2020.

Results: Fifty-three patients received rechallenge with another EGFR-TKI in the second-line (n = 38, 71.7%) or third-line (n = 15, 28.3%) setting. The primary reason for first-line osimertinib discontinuation was toxicity in 32 (60.4%, 17 patients with pneumonitis) and disease progression in 20 (37.7%) patients. The most common rechallenge EGFR-TKI was afatinib (n = 24, 45.3%), followed by gefitinib (n = 16, 30.2%) and erlotinib (n = 8, 15.1%). The real-world time to treatment failure (rwTTF) was 7.3 months. The rwTTF for the toxicity discontinuation and progressive disease discontinuation groups was 9.3 months and 5.1 months, respectively, (HR 1.61, p = 0.119). EGFR-TKI rechallenge was discontinued due to toxicity in nine patients (17.0%), but no patient developed pneumonitis.

Conclusion: EGFR-TKI rechallenge with another TKI is well tolerated in patients with EGFR-mutated NSCLC. Thus, it may be a useful treatment option after first-line osimertinib failure, especially after osimertinib discontinuation due to toxicity.

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来源期刊
Thoracic Cancer
Thoracic Cancer ONCOLOGY-RESPIRATORY SYSTEM
CiteScore
5.20
自引率
3.40%
发文量
439
审稿时长
2 months
期刊介绍: Thoracic Cancer aims to facilitate international collaboration and exchange of comprehensive and cutting-edge information on basic, translational, and applied clinical research in lung cancer, esophageal cancer, mediastinal cancer, breast cancer and other thoracic malignancies. Prevention, treatment and research relevant to Asia-Pacific is a focus area, but submissions from all regions are welcomed. The editors encourage contributions relevant to prevention, general thoracic surgery, medical oncology, radiology, radiation medicine, pathology, basic cancer research, as well as epidemiological and translational studies in thoracic cancer. Thoracic Cancer is the official publication of the Chinese Society of Lung Cancer, International Chinese Society of Thoracic Surgery and is endorsed by the Korean Association for the Study of Lung Cancer and the Hong Kong Cancer Therapy Society. The Journal publishes a range of article types including: Editorials, Invited Reviews, Mini Reviews, Original Articles, Clinical Guidelines, Technological Notes, Imaging in thoracic cancer, Meeting Reports, Case Reports, Letters to the Editor, Commentaries, and Brief Reports.
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