Điều trị bệnh nhân ung thư phổi không tế bào nhỏ di căn não có đột biến gen EGFR bằng gefitinib kết hợp xạ phẫu tổn thương não=Treatment of non-small cell lung cancer patients with brain metastasis harboring EGFR mutations by gefitinib combined brain radiosurgery

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Anh Tuấn Nguyễn, Đình Tiến Nguyễn, Minh Hải Nguyễn, Văn Luận Phạm, Văn Đại Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y dược lâm sàng 108, 2024

Mô tả vật lý: tr.7-16

Bộ sưu tập: Metadata

ID: 244866

Thêm vào giỏ

Đánh giá kết quả điều trị bệnh nhân (BN) ung thư phổi không tế bào nhỏ (UTPKTBN) di căn não có đột biến gen EGFR bằng gefitinib kết hợp với xạ phẫu tổn thương não. Đối tượng và phương pháp: Nghiên cứu tiến cứu, theo dõi dọc, 35 BN UTPKTBN di căn não 1 đến 3 ổ, có đột biến gen EGFR dương tính được điều trị gefitinib kết hợp với xạ phẫu u não. BN được đánh giá sau mỗi 3 tháng hoặc khi có triệu chứng của bệnh tiến triển. Tiêu chuẩn chính là thời gian sống thêm bệnh không tiến triển (Progression-Free Survival - PFS), tỉ lệ đáp ứng khách quan tại não (Objective Response Rate - ORR). Tiêu chuẩn phụ là tỉ lệ kiểm soát bệnh (Disease Control Rate - DCR), thời gian sống thêm toàn bộ (Overall Survival - OS), tác dụng không mong muốn của gefitinib và xạ phẫu u não. Kết quả: Tuổi trung bình của BN là 63,34 tuổi. Đau ngực và đau đầu là 2 triệu chứng thường gặp nhất chiếm lần lượt là 62,9% và 65,7%. Có 48,6% BN di căn não 1 ổ, 17,1% di căn não 2 ổ và 34,3% BN có 3 ổ di căn. Có 57,1% số BN mang đột biến gen EGFR loại mất đoạn trên exon 19 và 42,9% BN mang đột biến điểm L858R trên exon 21. ORR chung là 71,4% và DCR là 94,3%. ORR nội sọ là 80% với 34,3% đáp ứng hoàn toàn. Trung vị PFS 13 ± 0,92 tháng, Trung vị OS là 22 ± 5,8 tháng. Không có mối liên quan giữa thời gian sống thêm với vị trí đột biến gen EGFR loại mất đoạn exon 19 và L858R và số lượng ổ di căn não. Tác dụng không mong muốn liên quan đến điều trị gefitinib gặp ở 54,3% số BN, nhiều nhất là nổi ban với 37,2%. Có 3 BN xuất hiện triệu chứng tăng áp lực nội sọ sau xạ phẫu 48 giờ, 5 BN xuất hiện động kinh và 2 BN sa sút trí tuệ trong quá trình theo dõi sau điều trị. Kết luận: Điều trị gefitinib kết hợp với xạ phẫu tổn thương di căn não là một biện pháp hiệu quả và an toàn ở bệnh nhân ung thư phổi không tế bào nhỏ di căn não có đột biến gen EGFR.To evaluate the results of treatment for patients with non-small cell lung cancer (NSCLC) with brain metastasis (BM) harboring EGFR mutations using gefitinib combined with radiosurgery for brain damage. Subject and method: Prospective study, longitudinal follow-up, 35 patients with NSCLC with BM 1-3 lesions and EGFR mutations positive were treated by gefitinib combined brain radiosurgery. Patients are evaluated every 3 months or when symptoms of disease progression occur. The main criteria were progression-free survival (PFS), objective response rate (ORR) in the brain. Secondary criteria were disease control rate (DCR), overall survival (OS), adverse effects of gefitinib and brain radiosurgery. Result: The average age of patients was 63.34 years old. Chest pain and headache were the two most common symptoms, accounting for 62.9% and 65.7% respectively. There were 48.6% of patients with 1 BM, 17.1% with 2 BMs and 34.3% of patients with 3 BMs. There were 57.1% of patients carrying EGFR of exon 19 deletion mutation and 42.9% of patients with L858R point mutation on exon 21. The overall ORR was 71.4% and the overall DCR was 94.3%. Intracranial ORR was 80% with 34.3% complete response. Median PFS was 13 ± 0.92 months and median OS was 22 ± 5.8 months. There was no relationship between survival and the location of EGFR mutations and the number of brain metastasis. Adverse events related to gefitinib occurred in 54.3% of patients, the most common being rash with 37.2%. There were 3 patients with symptoms of increased intracranial pressure 48 hours after radiosurgery, 5 patients with epilepsy and 2 patients with dementia during post-treatment follow-up. Conclusion: Gefitinib combined with radiosurgery for brain metastasis is an effective and safe measure in patients with non-small cell lung cancer with brain metastasis harboring EGFR mutations.

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