Introduction: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are standard first-line treatments for advanced EGFR-mutated non-small-cell lung cancer (NSCLC) patients. The efficacy of EGFR-TKIs in older patients including poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) is seldom investigated.
Methods: We enrolled patients 65 years or older with EGFR-mutated Stage IIIB–IV NSCLC and evaluated the efficacy and prognosis of first-line EGFR-TKI treatment. Clinical and demographic characteristics were reviewed and analyzed, including age, sex, PS, smoking history, EGFR mutation type, treatment regimen, progression-free survival (PFS), and overall survival (OS).
Results: From January 2015 to December 2019, a total of 237 patients were included, 205 of whom were eligible for efficacy and outcome analyses. Among them, 91 (44.4%) were categorized as poor PS (2– 4). Compared with patients categorized as good PS (0– 1), those with poor PS were older (79 versus 75 years), had a higher proportion of brain metastases (41.8% versus 25.4%), more comorbidities (74.7% versus 54.4%), and more likely to be treated with first-generation TKIs (74.7% versus 57.0%). The PFS and OS were 17.1 and 26.7 months respectively in patients with good PS and 12.7 and 18.2 months in those with poor PS (both p < 0.001). In the multivariate analysis, good PS, < 3 metastatic sites, and first-line treatment with afatinib compared with erlotinib and gefitinib were associated with longer PFS. A relatively younger age, good PS, < 3 metastatic sites, and no brain metastasis at diagnosis were associated with better OS.
Conclusion: In older patients with EGFR-mutated NSCLC and receive EGFR-TKI treatment, a good PS and < 3 metastatic sites at diagnosis were associated with a longer PFS and OS. In addition, afatinib as first-line treatment was associated with a longer PFS whereas a relatively younger age and no brain metastasis at diagnosis were associated with better OS.

Keywords: older adults, epidermal growth factor receptor tyrosine kinase inhibitor, non-small-cell lung cancer, performance status


中文翻译：

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一线 EGFR 酪氨酸激酶抑制剂治疗老年人（包括表现不佳的 EGFR 突变非小细胞肺癌患者）的疗效和预后

简介：表皮生长因子受体酪氨酸激酶抑制剂 (EGFR-TKI) 是晚期EGFR突变的非小细胞肺癌 (NSCLC) 患者的标准一线治疗方法。很少研究 EGFR-TKI 在老年患者中的疗效，包括较差的东部肿瘤协作组 (ECOG) 体能状态 (PS)。
方法：我们招募了 65 岁或以上的EGFR突变 IIIB-IV 期 NSCLC 患者，并评估了一线 EGFR-TKI 治疗的疗效和预后。回顾和分析临床和人口统计学特征，包括年龄、性别、PS、吸烟史、EGFR突变类型、治疗方案、无进展生存期（PFS）和总生存期（OS）。
结果：2015 年 1 月至 2019 年 12 月，共纳入 237 名患者，其中 205 人符合疗效和结果分析的条件。其中，91 人（44.4%）被归类为 PS 差（2-4）。与分类为良好 PS (0-1) 的患者相比，PS 差的患者年龄更大（79 岁对 75 岁），脑转移比例更高（41.8% 对 25.4%），合并症更多（74.7% 对 54.4%） ，并且更有可能接受第一代 TKI 治疗（74.7% 对 57.0%）。PS 良好的患者的 PFS 和 OS 分别为 17.1 和 26.7 个月，PS 较差的患者的 PFS 和 OS 分别为 12.7 和 18.2 个月（均 p < 0.001）。在多变量分析中，与厄洛替尼和吉非替尼相比，良好的 PS、<3 个转移部位以及阿法替尼的一线治疗与更长的 PFS 相关。年龄比较小，PS不错，<
结论：在接受 EGFR-TKI 治疗的EGFR突变 NSCLC老年患者中，良好的 PS 和诊断时 < 3 个转移部位与较长的 PFS 和 OS 相关。此外，阿法替尼作为一线治疗与更长的 PFS 相关，而相对年轻且诊断时无脑转移与更好的 OS 相关。

关键词：老年人，表皮生长因子受体酪氨酸激酶抑制剂，非小细胞肺癌，体能状态