Prognoserelevanz von Body-Mass-Index und Rash für Patienten mit metastasiertem nichtkleinzelligem Lungenkarzinom unter Therapie mit Erlotinib

Zusammenfassung

Die Therapie mit Tyrosinkinasehemmern der EGFR Signalkaskade, wie z. B. Erlotinib bei Patienten mit nichtkleinzelligen Lungenkarzinomen im Stadium IV, gewinnt zunehmend an Bedeutung. Die Histologie ist ein bekannter Prognosefaktor für das Ansprechen auf diese Therapie, ebenso der EGF-Rezeptor-Mutationsstatus. Weitere Indikatoren, die mit der Prognose assoziiert sind, sind ungenügend definiert, insbesondere fehlen Angaben zur Rolle des Ernährungszustands des Patienten bei einer standardisierten Chemotherapiedosierung der Substanzgruppe. In der vorliegenden retrospektiven Analyse von 275 Patienten, die mit Erlotinib behandelt wurden, wurden weitere klinisch-prognostische Faktoren definiert. Eine stark ausgeprägte Hautreaktion (Rash) war insbesondere bei männlichen Patienten mit einer schlechten Prognose bezüglich des Gesamtüberlebens verbunden. Aktive Raucher entwickeln ebenfalls häufiger intensiven Rash als Nichtraucher und haben auch eine schlechtere Prognose. Patienten mit Untergewicht (BMI < 18) oder starkem Übergewicht (BMI > 30) entwickeln nicht häufiger starken Rash als normalgewichtige Patienten, haben unter Erlotinib jedoch auch ein schlechtes Gesamtüberleben. Klinisch relevante Prognosefaktoren wie z. B. der Ernährungszustand sollen in der Zukunft eine größere Rolle in der palliativen Therapie von Patienten mit NSCLC spielen.

Abstract

Tyrosine kinase inhibition (TKI) such as erlotinib is a well established treatment option in the palliative care of patients with non small cell lung cancer (NSCLC). Histology and sex have been associated with different prognostic outcome measures in patients treated with erlotinib. Furthermore, the degree of rash, developed during treatment might be a relevant marker in respect to tumor response. To dissect these clinical relevant features we analysed a cohort of 275 patients treated with erlotinib in different lines of chemotherapy in our hospital. Nutrition status plays an important role in the prognosis of patients in a palliative chemotherapeutic setting, we therefore included body mass index measurements (BMI) in our analysis. We found that BMI and smoking status influence different survival patterns. Male patients have a poorer survival based on low BMI, rash development and smoking status. We therefore conclude that both nutritional and smoking status should be taken into account in the surveillance of patients with NSCLC in a palliative therapeutic setting under TKI treatment.

• Literatur

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