Prognostic Values of Inflammatory Indexes and Clinical Factors in Patients with Epidermal Growth Factor Receptor Mutations in Lung Adenocarcinoma and Treated with Tyrosine Kinase Inhibitors.

Bee-Song Chang,Chun-Hou Huang,Yi-Feng Wu,Tsung-Cheng Hsieh,Tai-Chu Peng

doi:10.3390/jpm12030404

Bee-Song Chang, Chun-Hou Huang + Show 3 more

Open Access

https://doi.org/10.3390/jpm12030404

Copy DOI

Abstract

This study aimed to access the predictive value of inflammatory indices and clinical factors in toxicity and survival in patients with epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma receiving first-line tyrosine kinase inhibitor (TKI)-treatment. A total of 259 patients with stage IIIB–IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI treatment between 2008 and 2020 were retrospectively enrolled and analyzed. The prognostic factors of TKI-related toxicity, overall survival (OS), and progression-free survival (PFS) were identified by using logistic regression analysis and Cox proportional hazards models. Pre-TKI high platelet-to-lymphocyte ratio (PLR) was associated with post-TKI anemia. Hypoalbuminemia was associated with acneiform rash. Elderly age (≥70 years) and lower body mass index (<18.5 kg/m2) were also associated with hypoalbuminemia. Elderly age, stage IV, EGFR-mutated with L858R and uncommon mutations, and neutrophil-to-lymphocyte ratio were found to be independent prognostic factors for PFS, while elderly age, uncommon EGFR-related mutations, and lymphocyte-to-monocyte ratio were found to be independent prognostic factors for OS. A useful prognostic scoring tool for improving the survival risk stratification of patients was established by incorporating the above essential factors. Baseline hypoalbuminemia and PLR could be crucial clinical assessment factors when initiating TKI therapy. In addition, the optimization of individualized treatment strategies for these patients may be assisted by using the risk-scoring model.

Highlights

tyrosine kinase inhibitor (TKI) as the first-line treatment were included in the present study in accordance with the inclusion criteria
70% of lung adenocarcinoma patients harboring epidermal growth factor receptor (EGFR)-mutated develop resistance against TKI therapy, and cancer eventually progresses during treatment within the year [3]
Based on the literature review, the current study accesses the systemic inflammation indices and clinical features associated with the TKI treatment-related toxicities and survival outcomes of EGFR-mutated lung adenocarcinoma patients receiving first-line TKI therapy

Summary

Introduction

Lung cancer is the leading cause of cancer-related deaths, with over 1.8 million deaths expected worldwide in 2021 [1]. Molecular targeted therapies and immunotherapies for non-small-cell lung cancer (NSCLC) have substantially enhanced clinical outcomes over previous decades. Among the targetable driver mutations, the epidermal growth factor receptor (EGFR) gene is the most common. Several effective tyrosine kinase inhibitors (TKIs) are being used as a standard of care for EGFR-defined patients [2]. More than 70% of patients become resistant to targeted therapy and disease eventually progresses during treatment [3]. Drug resistance in patients with EGFR mutations cannot be precisely predicted. Reliable host factors are an essential and unmet requirement for obtaining predictive outcomes effectively [4]

Objectives

Methods

Results

Discussion

Conclusion