Pemetrexed tedavisi altında progresyon gösteren ileri evre küçük hücreli olmayan akciğer kanserli hastalarda tedavi seçeneklerinin retrospektif değerlendirilmesi
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Date
2018
Authors
Eylemer, Eda
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Akciğer kanseri dünyada kanserden ölümün en sık nedenidir. En sık küçük hücreli olmayan akciğer kanserleri (KHOAK) görülür. Tedavi planı; tümörün tipi, evrelemesi, KHOAK ise EGFR (Epidermal büyüme faktörü reseptörü), ALK (Anaplastik lenfoma kinaz), ROS1 gibi driver mutasyonların olup olmaması ve hastanın fonksiyonel kapasitesine göre yapılır. Dünyada standart tedavide birinci seçimde pemetrexed ve taksan bazlı tedaviler kullanılırken, ülkemizde bu kemoterapötik ajanlar ikinci seçimde kullanılmaktadır. Üçüncü seçimde optimal tedavi seçeneği belli değildir. Retrospektif olarak gerçekleştirdiğimiz bu çalışmanın amacı, 17.10.2010 – 17.10.2017 tarihleri arasında merkezimizde takip ettiğimiz 96 adet KHOAK'li hastada ikinci seçim pemetreksed sonrası üçüncü seçimde verdiğimiz tedavileri ve bu tedavilerin progresyonsuz sağkalım ile genel sağkalım oranlarını güncel literatür bilgileri ile karşılaştırmaktır. Beraberinde hastalarımızda yaş, cinsiyet, Eastern Cooperative Oncology Group (ECOG) performans skoru, metastaz varlığı bakılmış ve bu durumların da progresyonsuz sağkalım ile genel sağkalım etkileri incelenmiştir. Çalışmamızdaki hastaların büyük çoğunluğunun erkekler olduğu (%84,4) ve genel sağkalımın kadınlara göre daha yüksek olduğu görüldü (ortalama 53,4 hafta, p=0,04). Kranial metastazı olan ve ECOG performans skoru düşük olan hastaların genel sağkalımı üzerine etkisi anlamlı saptandı (p=0,023 ve p=0,003). Driver mutasyon taşımasalar bile üçüncü seçimde en sık verilen grup tirozin kinaz inhibitörleriydi (TKIs) (52 hasta). 48 hastaya erlotinib verildi. Üçüncü seçim tedavinin sağkalımı (p=0,015) ve progresyonsuz sağkalımı (p=0,022) arttırdığı görüldü. Tedavilerin birbirlerine üstünlükleri saptanmadı. TKIs alan hastaların sağkalımları ortalama 37,2 hafta, progresyonsuz sağkalımları da ortalama 18,1 hafta olarak belirlendi ve genel literatür bilgisine benzer olarak sonuçlandı. Sonuç olarak; çalışmamızda Erlotinib, diğer TKIs'lara ve sitotoksik ajanlara göre üstün bulunmasa da literatürde, üçüncü seçimde hasta eğer daha önce almadıysa Erlotinib tedavisini önerilmektedir.
Lung cancer is the most common cause of cancer death worldwide. Non–small cell lung cancer (NSCLC) is the most common of them. Treatment plan is based on factors as tumor type, stage, patient's functional capacity and whether there is a driving mutation such as EGFR (Epidermal growth factor receptor), ALK (Anaplastic lymphoma kinase), ROS1 if it is NSCLC. Pemetrexed and taksan based treatments are the first-line worldwide, whereas in our country these chemotherapeutic agents are used in second-line treatment. Optimal treatment is unclear in third-line. In this retrospective study that enrolled 96 patients with NSCLC who received pemetrexed as second-line treatment between 17.10.2010 and 17.10.2017, we aimed to compare the third-line treatment options and total survival rates and progression-free survival rates with literature. We studied patient's age, sex, Eastern Cooperative Oncology Group (ECOG) performance score, presence of metastasis and examined how these factors affecting total survival rates and progression-free survival rates. In our study, majority of patiens were males (%84.4) and in men total survival rate was higher than women (mean 53.4 weeks, p = 0.04). There was a statistically significant effect of lower ECOG performance and presence of cranial metastasis (p = 0.023 and p = 0.003). Tyrosine kinase inhibitors (TKIs) are the most common treatment option as third-line, even there was no driver mutation (52 patients). Erlotinib was received to 48 patients. Third-line treatment was found to increase total survival rates (p = 0.015) and progression-free survival rates (p= 0.022). No superiority was found between treatments. Survival was 37.2 weeks and progression-free survival was 18.1 weeks in patients recieved TKIs and these results are consistent with literature. In conclusion, although in our study results erlotinib is not superior than other TKIs and cytotoxic agents, erlotinib treatment is recommended as third-line if patient did not use it before.
Lung cancer is the most common cause of cancer death worldwide. Non–small cell lung cancer (NSCLC) is the most common of them. Treatment plan is based on factors as tumor type, stage, patient's functional capacity and whether there is a driving mutation such as EGFR (Epidermal growth factor receptor), ALK (Anaplastic lymphoma kinase), ROS1 if it is NSCLC. Pemetrexed and taksan based treatments are the first-line worldwide, whereas in our country these chemotherapeutic agents are used in second-line treatment. Optimal treatment is unclear in third-line. In this retrospective study that enrolled 96 patients with NSCLC who received pemetrexed as second-line treatment between 17.10.2010 and 17.10.2017, we aimed to compare the third-line treatment options and total survival rates and progression-free survival rates with literature. We studied patient's age, sex, Eastern Cooperative Oncology Group (ECOG) performance score, presence of metastasis and examined how these factors affecting total survival rates and progression-free survival rates. In our study, majority of patiens were males (%84.4) and in men total survival rate was higher than women (mean 53.4 weeks, p = 0.04). There was a statistically significant effect of lower ECOG performance and presence of cranial metastasis (p = 0.023 and p = 0.003). Tyrosine kinase inhibitors (TKIs) are the most common treatment option as third-line, even there was no driver mutation (52 patients). Erlotinib was received to 48 patients. Third-line treatment was found to increase total survival rates (p = 0.015) and progression-free survival rates (p= 0.022). No superiority was found between treatments. Survival was 37.2 weeks and progression-free survival was 18.1 weeks in patients recieved TKIs and these results are consistent with literature. In conclusion, although in our study results erlotinib is not superior than other TKIs and cytotoxic agents, erlotinib treatment is recommended as third-line if patient did not use it before.
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Keywords
Küçük hücreli olmayan akciğer kanseri, Üçüncü seçim, Pemetrexed, Erlotinib, Non small cell lung cancer, Third line
Citation
Eylemer, E. (2018). Pemetrexed tedavisi altında progresyon gösteren ileri evre küçük hücreli olmayan akciğer kanserli hastalarda tedavi seçeneklerinin retrospektif değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.