Outcomes of Mechanically Ventilated Non-Small Cell Lung Cancer Patients Receiving Tyrosine Kinase Inhibitors in Intensive Care Units

前言：標靶藥物—表皮生長因子接受器- 酪胺酸激?抑制劑（epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs）在非小細胞肺癌併呼吸器支持的病人上，其臨床療效尚不明確。本篇研究旨在探討呼吸器支持下的非小細胞肺癌病人接受標靶藥物治療的成果。 方法：自2004 年1 月1 號至2010 年7 月1 號加護病房中的回溯性分析。 結果：91 位非小細胞肺癌併呼吸器支持的病人使用標靶藥物EGFR-TKIs，33 人（36%）成功脫離呼吸器，其中有13 人（14%）對標靶治療有反應。年齡、性別、日常體能狀態（performance status）、APACHE II score、腫瘤分型和期別不影響呼吸器的脫離。進入加護病房前腫瘤在穩定狀態（controlled disease）或在加護病房中對標靶藥物治療有反應的病人有較高的比例成功脫離呼吸器（分別為39% 和52%）。 結論：原腫瘤在穩定狀態或對標靶治療有反應的非小細胞肺癌患者，即使在接受呼吸器支持下，仍值得更積極的治療。
Background: The clinical response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) of critically ill non-small cell lung cancer (NSCLC) patients has not been well addressed. The purpose of this study was to investigate the outcome of mechanically-ventilated (MV) NSCLC patients under EGFR-TKI treatment. Methods: A retrospective study of NSCLC patients in medical intensive care units (ICUs) between January 1, 2004 and July 1, 2010. Results: Thirty-three (36%) of the 91 NSCLC patients with MV taking EGFR-TKIs were successfully weaned from MV, including 13 (14%) who were responsive to EGFR-TKI treatment. Age, gender, performance status, Acute Physiology and Chronic Health Evaluation II score, cancer cell type and stage did not affect the outcome of MV weaning. Patients with controlled disease before ICU admission and those with EGFR-TKI response in the ICU achieved a significantly higher rate of successful weaning (39% and 52%, respectively). Conclusions: NSCLC patients with controlled disease or EGFR-TKI response may need more aggressive management, even if they are under MV.