EGFR mutasyonu veya ALK translokasyonu olan küçük hücreli dışı akciğer kanseri (KHDAK) tanılı hastaların klinik özelliklerinin ve yönetiminin incelenmesi: retrospektif gözlemsel çok merkezli vaka serisi çalışması
Giriş: Akciğer kanseri, kansere bağlı ölümlerin önde gelen nedenlerinden biridir. Akciğer kanserinin en yaygın tipi Küçük hücreli dışı akciğer kanseri (KHDAK) 'dir. Moleküler hedefli ilaçlar, sürücü mutasyon içeren metastatik KHDAK'lı hastaların tedavisinde kullanılır. Bu çalışmada, sürücü mutasyonu bulunan KHDAK hastalarında birinci basamakta seçilen tedavi şekli, hasta özellikleri ve sonuçları arasındaki ilişkiyi araştırmayı amaçladık. Materyal-Metod: Bu retrospektif çalışmayı, KHDAK hastalarında tirozin kinaz inhibitörlerinin kullanıldığı tedavi basamağının sağkalım parametreleri ve hastalık prognozu üzerine etkisini analiz etmek için tasarladık. Üç kanser merkezinden (Şanlıurfa Araştırma ve Eğitim Hastanesi, Başkent Üniversitesi ve Acıbadem Mehmet Ali Aydınlar Üniversitesi medikal onkoloji) sürücü mutasyonları bulunan 62 KHDAK hastasını kayıt ettik Sonuçlar: Ortanca yaş 62 idi (aralık 30-81). EGFR mutasyonu ve EML4-ALK füzyon geni bulunan sırasıyla 45 (% 71.4) ve 18 (% 28.6) hasta vardı. EGFR mutant 45 hastanın 22'sinde (% 34.9) ekson 19 delesyon vardı ve diğer 16 hastada (% 25.4) ekson 21 mutasyonu vardı. Ortanca genel sağkalım (OS) ve progresyonsuz sağkalım (PFS) sırasıyla 31 ve 9 (% 95 CL, 5.4-12.6) ay idi. Tek değişkenli istatistiksel analiz, EGFR mutasyonu pozitif ve FISH-ALK pozitif hastalar arasında OS ve PFS açısından anlamlı farklılık göstermedi (p: 0.33). EGFR mutasyonu bulunan hastalar arasında, ekson 19 delesyonu olan hastalarda sağkalım süresi, ekson 21 mutasyonları olanlara göre istatistiksel olarak anlamlı derecede yüksekti (p: 0.02). Oligometastatik hastaların genel sağkalım süresi diğer hastalardan istatistiksel olarak anlamlı derecede yüksekti (p: 0.001). Birinci basamak tedavide tirozin kinaz inhibitörü alan hastaların PFS'si birinci basamakta kemoterapiyi kullanan hastalardan istatistiksel olarak anlamlı derecede yüksekti. (14 ay vs 5 ay) (p: 0.01). Tartışma: Bu çalışma, birinci basamak tedavide tirozin kinaz inhibitörleri lehine tedavi tercihinin, sürücü mutasyonları olan metastatik KHDAK hastalarında oldukça iyi sonuçlar verdiğini göstermiştir
Non-small-cell lung cancer (NSCLC) harboring driver mutation (EGFR mutation or ALK translocations) with clinical characteristics and management in a real-life setting: a retrospective observational multicenter case series study
Introduction: Lung cancer is a leading cause of cancer-related mortality. The most common type of lung cancer is Non-small-cell lung cancer (NSCLC). Molecular targeting drugs are used in the treatment of patients with metastatic NSCLC who have a driver mutation. In this study, we aimed to investigate the relationship between the selected treatment modality in the first line setting, patients characteristics and outcomes on NSCLC patients who had driver mutations.Material and Method: We designed this retrospective study to analyze the effect of the treatment line of tyrosine kinase inhibitors on survival parameters and disease prognosis in NSCLC patients. We enrolled 62 patients with NSCLC who had driver mutations from three cancer centers; Şanlıurfa Research and Training Hospital, Başkent University, and Acıbadem Mehmet Ali Aydınlar University medical oncology departments. Results: Median age was 62 years old (range 30-81). There were 45 (71.4%) and 18 (28.6%) patients with EGFR mutation and EML4-ALK fusion gene rearrangement, respectively. Out of 45 EGFR mutant patients, 22 (34.9%) patients had exon 19 deletion and other 16 (25.4%) patients had exon 21 mutation. Median overall survival (OS) and progression free survival (PFS) was 31 and 9 (95% CI, 5.4-12.6) months, respectively. Univariate statistical analysis failed to show significant difference between EGFR mutation positive and FISH-ALK positive patients regarding OS and PFS (p:0.33). Among patients with EGFR mutation, survival times for patients with exon 19 deletions were statistically significantly higher than those with exon 21 mutations (p:0.02). The overall survival time of oligometastatic patients was statistically significantly higher than the other patients (p:0.001). The PFS of patients who received tyrosine kinase inhibitor in first-line treatment was statistically significantly higher than patients using chemotherapy in first line setting. (14 months vs 5 months) (p:0.01) Conclusion: This study showed that treatment preference in favor of tyrosine kinase inhibitors in first line setting produce fairly good outcomes in metastatic NSCLC patients who had driver mutations.
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