Опухоли головы и шеи. 2012; : 63-65
ГЕФИТИНИБ (ИРЕССА) В ЛЕЧЕНИИ МЕТАСТАЗОВ НЕМЕЛКОКЛЕТОЧНОГО РАКА ЛЕГКОГО В ГОЛОВНОМ МОЗГЕ
https://doi.org/10.17650/2222-1468-2012-0-3-63-65Аннотация
В ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН с 2006 г. проводится исследование по изучению эффективности таргетной терапии препаратом гефитиниб у больных немелкоклеточным раком легкого (НМРЛ) с метастазами в головном мозге. При оценке эффективности лечения у 9 больных с наличием мутации EGFR в опухоли полная регрессия достигнута у 1 (11,1 %) пациента, частичная регрессия – у 5 (55,6 %) больных, стабилизация болезни – у 3 (33,3 %). Медиана времени до прогрессирования составила 7 мес, медиана выживаемости у пациентов не достигнута. При оценке эффективности лечения в группе из 6 больных без наличия мутации EGFR или с отсутствием информации о мутации EGFR в опухоли полных и частичных регрессий не отмечено, стабилизация болезни отмечена у 3 (50,0 %) пациентов, прогрессирование болезни – у 3 (50 %). Медиана времени до прогрессирования составила 2 мес, медиана выживаемости пациентов – 5 мес. Таким образом, высокая эффективность лечения ингибитором EGFR гефитинибом больных НМРЛ с метастазами в головном мозге достигнута только в группе пациентов с выявленными мутациями 18–21-го экзонов EGFR в опухоли. Определение статуса EGFR в опухоли является важнейшим прогностическим фактором при назначении терапии тирозинкиназным ингибитором EGFR гефитинибом у больных с метастазами в головном мозге. Исследование продолжается.
Список литературы
1. Cappuzzo F., Calandidi C., Bartolini S. et al. ZD 1839 in patients with brain metastases from non-small-cell lung cancer (NSCLC): report of four cases. Br J Cancer 2003;89:246–7.
2. Gaspar L., Scott C. Rotman L. et al. Recursive partitioning analisys (RPA) of prognostic factors in there Radiation Therapy Oncology Groups (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997;37:745–51.
3. Gurpide A., Perez-Gracia J.L., Lopez- Picazo J.M. et al. Activity of gefitinib in central nervous system metastases in patients with non-small-cell lung cancer: two case reports and review of the literature. Clinical Lung Cancer 2005 Sep;7(2):138–40.
4. Kim K., Lee D.H., Lee J. et al. Efficacy of epidermal growth factor receptor tyrosine kinase inhibitors for brain metastasis in non-small cell lung cancer patients harboring either exon 19 or 21 mutations. J Clin Oncol 2011;29(suppl; abstr. 7606).
5. Li Z., Lu J., Zhao Y. et al. The retrospective analysis of the frequency of EGFR mutations and the efficacy of gefitinib in NSCLC patients with brain metastasis. J Clin Oncol 2011;29(suppl; abstr. e18065).
6. Maemondo M., Inoue A., Kobayashi K. et al. Gefitinib or chemotherapy for nonsmall- cell lung cancer with mutated EGFR. N Engl J Med 2010;362:2380–8.
7. Mok T.S., Wu Y.L., Thongprasert S. et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009;361(10):947–57.
8. Namba Y., Kijima T., Yokota S. et al. Gefitinib in patients with brain metastases from non-small-cell lung cancer : review of 15 clinical cases. Clinical Lung Cancer 2004;6(2):123–8.
9. Poon A.N., Ho S.S., Yeo W., Mok T.S. Brain metastasis responding to gefitinib alone. Oncology 2004;67(2):174–8.
10. Yang C.H., Fukuoka M., Mok T.S. et al. Final overall survival results from a phase III randomized, open-label, first-line study of gefitinib vs carboplatin/paclitaxel in clinically selected patients with advanced non-small-cell lung cancer in Asia (IPASS). Ann Oncol 2010;21(suppl. 8):viii1.
Head and Neck Tumors (HNT). 2012; : 63-65
GEFITINIB (IRESSA) IN THE TREATMENT OF BRAIN METASTASES FROM NON-SMALL CELL LUNG CARCINOMA
https://doi.org/10.17650/2222-1468-2012-0-3-63-65Abstract
Since 2006, the N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, has been conducting an investigation of the efficiency of targeted therapy with gefitinib in patients with brain metastasis from non-small cell lung carcinoma (NSCLC). The evaluation of treatment efficiency in 9 patients with tumor EGFR mutation in NSCLC revealed that 1 (11.1 %) and 5 (55.6 %) patients achieved complete and partial regression, respectively; disease stabilization was observed in 3 (33.3 %). The median time to progression was 7 months; the patients did not achieve the median survival. The evaluation of treatment efficiency in a group of 6 patients without tumor EGFR mutation or its evidence showed complete and partial tumor regressions; disease stabilization was noted in 3 (50.0 %); disease progression was in 3 (50 %). The median time to progression was 2 months; the median survival was 5 months. Thus, the high efficiency of treatment with the EGFR inhibitor gefitinib in patients with brain metastases from NSCLS was achieved only in a group of patients with found ECFR mutations in exons 18–21 in the tumor. Determination of the status of ECFR in the tumor is the most important prognostic factor when using therapy with the EGFR tyrosine kinase inhibitor gefitinib in patients with brain metastases. The investigation is being continued.
References
1. Cappuzzo F., Calandidi C., Bartolini S. et al. ZD 1839 in patients with brain metastases from non-small-cell lung cancer (NSCLC): report of four cases. Br J Cancer 2003;89:246–7.
2. Gaspar L., Scott C. Rotman L. et al. Recursive partitioning analisys (RPA) of prognostic factors in there Radiation Therapy Oncology Groups (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 1997;37:745–51.
3. Gurpide A., Perez-Gracia J.L., Lopez- Picazo J.M. et al. Activity of gefitinib in central nervous system metastases in patients with non-small-cell lung cancer: two case reports and review of the literature. Clinical Lung Cancer 2005 Sep;7(2):138–40.
4. Kim K., Lee D.H., Lee J. et al. Efficacy of epidermal growth factor receptor tyrosine kinase inhibitors for brain metastasis in non-small cell lung cancer patients harboring either exon 19 or 21 mutations. J Clin Oncol 2011;29(suppl; abstr. 7606).
5. Li Z., Lu J., Zhao Y. et al. The retrospective analysis of the frequency of EGFR mutations and the efficacy of gefitinib in NSCLC patients with brain metastasis. J Clin Oncol 2011;29(suppl; abstr. e18065).
6. Maemondo M., Inoue A., Kobayashi K. et al. Gefitinib or chemotherapy for nonsmall- cell lung cancer with mutated EGFR. N Engl J Med 2010;362:2380–8.
7. Mok T.S., Wu Y.L., Thongprasert S. et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009;361(10):947–57.
8. Namba Y., Kijima T., Yokota S. et al. Gefitinib in patients with brain metastases from non-small-cell lung cancer : review of 15 clinical cases. Clinical Lung Cancer 2004;6(2):123–8.
9. Poon A.N., Ho S.S., Yeo W., Mok T.S. Brain metastasis responding to gefitinib alone. Oncology 2004;67(2):174–8.
10. Yang C.H., Fukuoka M., Mok T.S. et al. Final overall survival results from a phase III randomized, open-label, first-line study of gefitinib vs carboplatin/paclitaxel in clinically selected patients with advanced non-small-cell lung cancer in Asia (IPASS). Ann Oncol 2010;21(suppl. 8):viii1.
