Clinical effect of EGFR-TKIs combined with platinum-containing chemotherapy and whole brain radiotherapy in the treatment of non-small cell lung cancer with brain metastasis / 中国医师进修杂志

ABSTRACT

Objective To explore the clinical effect of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKIs) gefitinib combined with platinum-containing chemotherapy and whole brain radiotherapy in the treatment of non-small cell lung cancer (NSCLC) with brain metastasis. Methods One hundred and fifty-six patients of NSCLC with brain metastasis were divided into observation group (82 cases) and control group (74 cases) according to the therapeutic regimens. On basis of whole brain radiotherapy, the patients in control group received platinum-containing chemotherapy (paclitaxel+cis-platinum+pemetrexed), while the patients in observation group received gefitinib. The serum levels of carcino-embryonic antigen (CEA), cytokeratin 19 fragment antigen (CYFRA21-1) and EGFR, short-term effects, progression-free survival (PFS) and incidences of adverse reactions between two groups were evaluated. A subgroup analysis was carried on the 41 cases of patients with EGFR mutant type. The short-term effects and PFS between two groups were compared. Results The levels of CYFRA21-1 and EGFR in observation group were obviously lower than those in control group (P<0.01). The ORR and DCR in observation group was obviously higher than that in control group (81.71％ vs. 36.49％, 93.90％ vs. 82.43％) (P < 0.05 or < 0.01). The median PFS in observation group and control group was 12 months and 6months. There were statistic differences between two groups (P < 0.05). Subgroup analysis showed that the ORR and DCR in observation group was obviously higher than that in control group (72.0％vs. 25.0％, 96.0％vs. 31.25％)(P<0.01). The median PFS in observation group and control group was 13 months and 5 months. There were statistic differences between two groups (P<0.05). There was no statistic difference in incidences of adverse reactions between two groups (P>0.05). Conclusions For patients with NSCLC with brain metastasis, compared with the therapeutic regimen of whole brain radiotherapy + platinum-containing chemotherapy, whole brain radiotherapy + platinum-containing chemotherapy+EGFR-TKIs (gefitinib) could more effectively reduce the levels of EGFR and CYFRA21-1, improve short-term effects, prolong PFS and do not increase the incidence of adverse reactions.