Tuberc Respir Dis.  2015 Oct;78(4):315-320. 10.4046/trd.2015.78.4.315.

The Prognostic Value of the Tumor Shrinkage Rate for Progression-Free Survival in Patients with Non-Small Cell Lung Cancer Receiving Gefitinib

Affiliations
  • 1Division of Pulmonary, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea. vov-x@daum.net
  • 2Department of Radiology, Chungnam National University Hospital, Daejeon, Korea.
  • 3Department of Preventive Medicine, Chungnam National University Hospital, Daejeon, Korea.

Abstract

BACKGROUND
The efficacy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy can be measured based on the rate of treatment response, based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria or progression-free survival (PFS). However, there are some patients harboring sensitive EGFR mutations who responded poorly to EGFR-TKI therapy. In addition, there is variability in the PFS after EGFR-TKI treatment.
METHODS
We performed a retrospective analysis of the medical records of 85 patients with non-small cell lung cancer, who had achieved a stable disease or better response at the first evaluation of treatment response, after receiving a 2-month course of gefitinib. We calculated the tumor shrinkage rate (TSR) by measuring the longest and perpendicular diameter of the main mass on computed tomography before, and 2 months after, gefitinib therapy.
RESULTS
There was a significant positive correlation between the TSR and PFS (R=0.373, p=0.010). In addition, a simple linear regression analysis showed that the TSR might be an indicator for the PFS (B+/-standard error, 244.54+/-66.79; p=0.001). On univariate analysis, the sex, histologic type, smoking history and the number of prior chemotherapy regimens, were significant prognostic factors. On multivariate regression analysis, both the TSR (beta=0.257, p=0.029) and adenocarcinoma (beta=0.323, p=0.005) were independent prognostic factors for PFS.
CONCLUSION
Our results showed that the TSR might be an early prognostic indicator for PFS in patients receiving EGFR-TKI therapy.

Keyword

EGFR Tyrosine Kinase Inhibitor; Gefitinib; Carcinoma, Non-Small Cell Lung; Progression-Free Survival

MeSH Terms

Adenocarcinoma
Carcinoma, Non-Small-Cell Lung*
Disease-Free Survival*
Drug Therapy
Humans
Linear Models
Medical Records
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor
Retrospective Studies
Smoke
Smoking
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor
Smoke

Figure

  • Figure 1 Method of tumor size measurement. The size of the tumor was defined as the section with the longest diameter among the axial, coronal, and sagittal sections of the main mass multiplied by the perpendicular diameter. In this patient, the longest diameter (a) and the longest perpendicular diameter (b) are obtained and multiplied on the coronal section.

  • Figure 2 (A) Correlation of tumor shrinkage rate (TSR) and progression-free survival (PFS). (B) Correlation of TSR calculated in all target lesions of Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria and PFS. (C) Correlation of response rate (%) calculated by sum of diameters according to RECIST 1.1 criteria and PFS.

  • Figure 3 Schema that represents different ratio of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) sensitive cells after administration of EGFR-TKI and discontinuation based on the ratio of EGFR-TKI sensitive cells before treatment. Upper case represents a tumor that has higher ratio of EGFR-TKI sensitive cells than lower case.


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