Tao Jiang1, Qian Chu2, Huijuan Wang3, Fei Zhou1, Guanghui Gao1,4, Xiaoxia Chen1, Xuefei Li5, Chao Zhao5, Qinghua Xu6, Wěi Li1, Fengying Wu1, Anwen Xiong5, Jing Zhao1, Yaping Xu6, Chunxia Su1, Shengxiang Ren1, Caicun Zhou1, Fred R. Hirsch7
1Department of Medical Oncology Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine Shanghai China
2Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
3Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
4Department of Oncology, The Third Affiliated Hospital of Soochow University, Soochow, China
5Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
6Department of Radiation Oncology Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine Shanghai China
7Medicine and Pathology, University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, CO
Tóm tắt
To investigate whether addition of local therapy to EGFR‐TKIs could provide survival benefit than EGFR‐TKIs alone in EGFR‐mutant NSCLC patients with oligometastatic or oligoprogressive liver metastases (LM). Patients with EGFR‐mutant NSCLC and oligometastatic or oligoprogressive LM who met inclusion criteria were retrospectively identified. The primary endpoint was progression‐free survival (PFS); secondary endpoints included overall survival (OS) and patterns of failure. Addition of local therapy was associated with a significantly longer PFS (13.8 vs. 8.6 m, p <0.001) and OS (31.2 vs. 18.5 m, p <0.001) in whole group. In oligometastatic cohort, 20 patients received EGFR‐TKIs and 23 received EGFR‐TKIs plus local therapy as first‐line treatment. Addition of local therapy showed a significantly longer PFS (12.9 vs. 7.9 m, p = 0.041) and OS (36.8 vs. 21.3 m, p = 0.034) than EGFR‐TKIs alone. In oligoprogressive cohort, 24 patients received continuation of EGFR‐TKIs plus local therapy and 25 received switching chemotherapy. Median PFS2 (13.9 vs. 9.2 m, p = 0.007) and OS (28.3 vs. 17.1 m, p = 0.011) was significantly longer in combined group than in switching chemotherapy group. Distant metastatic sites progression was the major pattern of failure in combined group while locoregional recurrence was the major reason in monotherapy or switching chemotherapy group. Our study suggested that EGFR‐TKIs plus local therapy showed prolonged survival benefit than EGFR‐TKIs alone in EGFR‐mutant NSCLC patients with oligometastatic or oligoprogressive LM, indicating addition of local therapy would be alternative choice in this clinical scenario.
