文章摘要

非小细胞肺癌脑膜转移的个体化治疗分析

作者: 1苗茜, 1郑晓彬, 1张龙凤, 1吴标, 1蒋侃, 1林根
1 福建省肿瘤医院(福建医科大学附属肿瘤医院)胸部内科,福州 350014
通讯: 林根 Email: lingen197505@163.com
DOI: 10.3978/j.issn.2095-6959.2020.12.004

摘要

目的:对非小细胞肺癌(non-small cell lung cancer,NSCLC)脑膜转移(leptomeningeal metastasis,LM)患者的个体化治疗行探索性分析。方法:选择于2018年12月至2020年3月福建省肿瘤医院确诊收治的NSCLC合并LM患者18例,收集患者临床诊治资料及生存随访。结果:18例患者中表皮生长因子受体(epidermal growth factor receptor,EGFR)突变14例,间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)突变1例,ROS原癌基因1(ROS proto-oncogene 1 ROS1)突变1例,野生型2例。合并基因突变的LM患者接受以酪氨酸激酶抑制剂(tyrosine-kinase inhibitor,TKI)为基础的靶向治疗联合,或不联合全身及局部综合治疗;共14例患者接受鞘内注射(intrathecal chemotherapy,ITC)培美曲塞治疗。根据神经肿瘤评估标准(response assessment in neuro-oncology,RANO)进行疗效评价,其中12例患者好转,2例稳定,4例进展。结论:NSCLC合并LM需要个性化综合治疗,对存在基因突变的患者采用TKI靶向治疗仍为基石,鞘内注射培美曲塞可能成为一种治疗选择。
关键词: 非小细胞肺癌;脑膜转移;靶向治疗;鞘内注射治疗;培美曲塞

Analysis of individualized therapy for leptomeningeal metastasis of non-small cell lung cancer

Authors: 1MIAO Qian, 1ZHENG Xiaobin, 1ZHANG Longfeng, 1WU Biao, 1JIANG Kan, 1LIN Gen
1 Department of Thoracic Oncology, Fujian Provincial Cancer Hospital, Affiliated Cancer Hospital of Fujian Medical University, Fuzhou 350014, China

CorrespondingAuthor: LIN Gen Email: lingen197505@163.com

Abstract

Objective: To conduct an exploratory analysis of individualized treatment of leptomeningeal metastasis (LM) in patients with non-small cell lung cancer (NSCLC). Methods: Eighteen NSCLC patients with LM admitted to Fujian Provincial Cancer Hospital from December 2018 to March 2020 were selected. Clinical and treatment data and survival follow-up of patients with LM were collected. Results: Fourteen patients harbored epidermal growth factor receptor (EGFR) mutations, 1 anaplastic lymphoma kinase (ALK) fusion, 1 proto-oncogene 1 (ROS1) fusion, and 2 wild-type. LM patients with genetic mutations received tyrosine kinase inhibitor (TKI)-based targeted therapy with or without combined systemic and local comprehensive treatment. A total of 14 patients received intrathecal chemotherapy (ITC) with pemetrexed. According to the response assessment in neuro-oncology (RANO), 12 of 18 patients were evaluated as responding, 2 were stable, and 4 were progressive. Conclusion: Individualized comprehensive treatment can prolong the survival of patients of LM. The targeted therapy of patients harbored genetic mutations is still the cornerstone, and ITC of pemetrexed may become a treatment option.
Keywords: non-small cell lung cancer; leptomeningeal metastasis; targeted therapy; intrathecal chemotherapy; pemetrexed