Wu Jenn-Yu, Yu Chong-Jen, Yang Chih-Hsin, Wu Shang-Gin, Chiu Yueh-Hsia, Gow Chien-Hung, Chang Yeun-Chung, Hsu Ya-Chieh, Wei Pin-Fei, Shih Jin-Yuan, Yang Pan-Chyr
Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan.
Am J Respir Crit Care Med. 2008 Oct 15;178(8):847-53. doi: 10.1164/rccm.200803-389OC. Epub 2008 Jun 26.
Gefitinib is effective in treating patients with non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations. Deletions in exon 19 and L858R in exon 21 are the best-documented EGFR mutations that are associated with effective gefitinib responsiveness.
To clarify the influence of gefitinib timing, we conducted a study to compare the outcomes of different lines of gefitinib treatment in patients with exon 19 deletions or L858R.
We surveyed the clinical data and mutational studies of patients with NSCLC with EGFR mutations in the National Taiwan University Hospital (Taipei, Taiwan).
Three hundred and twenty-eight patients, who received gefitinib for stage IIIb or IV NSCLC, were adequately sequenced for EGFR mutations; 192 patients had mutant EGFR, including 77 patients with exon 19 deletions and 75 patients with L858R. The 152 patients with exon 19 deletions or L858R and who were receiving gefitinib were classified into a chemonaive group (91 patients) or a chemotherapy-treated group (61 patients). Chemonaive status before gefitinib and female sex were associated with clinical response to gefitinib (P = 0.006 and 0.053, respectively). Neither overall survival after the start of antitumor therapy nor progression-free survival after gefitinib therapy was significantly different between these two groups (P = 0.207 and 0.804, respectively). Clinical response to gefitinib was the only factor associated with better overall survival (P = 0.001).
This study suggests that gefitinib is effective in patients with EGFR mutations. The gefitinib response rate in chemonaive patients is higher than in chemotherapy-treated patients; however, there is no difference in overall survival.
吉非替尼对治疗表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者有效。外显子19缺失和外显子21的L858R是与吉非替尼有效反应相关的记录最完善的EGFR突变。
为阐明吉非替尼用药时机的影响，我们开展了一项研究，比较外显子19缺失或L858R患者不同疗程吉非替尼治疗的结果。
我们调查了台湾大学医院（台北，台湾）NSCLC伴EGFR突变患者的临床数据和突变研究。
328例接受吉非替尼治疗IIIb期或IV期NSCLC的患者进行了EGFR突变的充分测序；192例患者EGFR突变，其中77例为外显子19缺失，75例为L858R。152例接受吉非替尼治疗的外显子19缺失或L858R患者分为初治组（91例）或化疗组（61例）。吉非替尼治疗前的初治状态和女性与吉非替尼的临床反应相关（P分别为0.006和0.053）。这两组患者在开始抗肿瘤治疗后的总生存期和吉非替尼治疗后的无进展生存期均无显著差异（P分别为0.207和0.804）。对吉非替尼的临床反应是与更好的总生存期相关的唯一因素（P = 0.001）。
本研究表明吉非替尼对EGFR突变患者有效。初治患者的吉非替尼反应率高于化疗患者；然而，总生存期无差异。
