İleri Evre Akciğer Adenokarsinomunda Pemetrexed Sonrasındaki Tedavi Seçeneklerinin Retrospektif Değerlendirmesi

Öz

İleri evre akciğer adenokarsinomunda ikinci basamak tedavi sonrasındaki tedavi seçenekleri sınırlı kalmaktadır. Bu çalışmada, 2010–2017 yılları arasında Bursa Uludağ Üniversitesi Tıp Fakültesi’nde metastatik akciğer adenokarsinomu tanısıyla tedavi edilen 95 hastada tedavi paternleri ve sağkalım sonuçları retrospektif olarak değerlendirildi. Genel sağkalım (OS) ve progresyonsuz sağkalım (PFS), üçüncü basamak tedavinin başlangıcından itibaren hesaplandı. Tirozin kinaz inhibitörleri (TKI’lar) 52 hastaya (%54,7) uygulandı. Hem medyan PFS hem de OS, TKI grubunda sayısal olarak daha iyi olmakla birlikte istatistiksel anlamlılığa ulaşmadı (PFS: 4,4 vs. 3,0 ay, log-rank p=0,059; OS: 8,6 vs. 7,4 ay, log-rank p=0,66). Bununla birlikte, çok değişkenli Cox regresyon analizinde üçüncü basamak TKI tedavisi, PFS’de iyileşme ile bağımsız olarak ilişkili bulundu (HR=0,52; %95 GA 0,31–0,85; p=0,01). Erkek cinsiyetin daha kötü OS (HR = 2,02; %95 GA 1,04–3,91; p=0,036) ve PFS (HR=2,46; %95 GA 1,24–4,90; p=0,01) ile bağımsız olarak ilişkili olduğu saptandı. Kötü ECOG performans durumu daha kötü OS (HR=2,30; %95 GA 1,40–3,79; p<0,001) ve PFS (HR=1,80; %95 GA 1,08–3,01; p=0,023) ile ilişkiliydi. Beyin metastazı varlığı da daha kötü OS (HR=1,77; %95 GA 1,10–2,85; p=0,018) ve PFS (HR=1,75; %95 GA 1,08–2,84; p=0,022) ile ilişkili bulunurken, karaciğer metastazı varlığı anlamlı derecede daha kötü OS ile ilişkiliydi (HR=1,72; %95 GA 1,06–2,80; p=0,028). Retrospektif, tek merkezli tasarımına ve sınırlı moleküler verilere rağmen bu gerçek yaşam kohortu, platin bazlı kemoterapi ve TKI’ların ileri basamak tedavinin temelini oluşturduğu rutin klinik uygulamayı yansıtmaktadır.

Anahtar Kelimeler

• Yassı hücreli olmayan küçük hücre dışı akciğer kanseri
• Metastaz
• Erlotinib
• Pemetreksed

Retrospective Analysis of Treatment Options after Progression on Pemetrexed in Advanced Lung Adenocarcinoma

Öz

Treatment options beyond second-line therapy in advanced lung adenocarcinoma remain limited. We retrospectively evaluated treatment patterns and survival outcomes in 95 patients with metastatic lung adenocarcinoma treated at Bursa Uludag University Faculty of Medicine between 2010 and 2017. Overall survival (OS) and progression-free survival (PFS) were calculated from the start of third-line therapy. Tyrosine kinase inhibitors (TKIs) were administered to 52 patients (54.7%). Both median PFS and OS numerically favored the TKI group but did not reach statistical significance (PFS: 4.4 vs. 3.0 months, log-rank p = 0.059; OS: 8.6 vs. 7.4 months, log rank p=0.66). However, in multivariate Cox regression analysis, third-line TKI therapy was independently associated with improved PFS (HR=0.52; 95% CI 0.31–0.85; p=0.01). Male sex was independently associated with worse OS (HR = 2.02; 95% CI 1.04–3.91; p=0.036) and PFS (HR=2.46; 95% CI 1.24–4.90; p=0.01). Poor ECOG performance status was associated with worse OS (HR = 2.30; 95% CI 1.40–3.79; p<0.001) and PFS (HR=1.80; 95% CI 1.08–3.01; p=0.023). Brain metastasis was also associated with poorer OS (HR=1.77; 95% CI 1.10–2.85; p=0.018) and PFS (HR=1.75; 95% CI 1.08–2.84; p=0.022) and the presence of liver metastasis was associated with significantly poorer OS (HR=1.72; 95% CI 1.06–2.80; p=0.028). Despite its retrospective, single-center design and limited molecular data, this real-world cohort reflects routine clinical practice, in which platinum-based chemotherapy and TKIs formed the backbone of later-line treatment.

Anahtar Kelimeler

• Non-squamosus non small lung cancer
• Metastasis
• Erlotinib
• Pemetrexed

Kaynakça

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