Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
Clin Lung Cancer. 2010 Jul 1;11(4):257-63. doi: 10.3816/CLC.2010.n.033.
Gefitinib and cetuximab are both epidermal growth factor receptor (EGFR) target therapies used to treat patients with non-small-cell lung cancer (NSCLC) with different mechanisms. To clarify the effectiveness of cetuximab after failure of gefitinib treatment, we investigated the clinical features of patients with NSCLC who received cetuximab-containing chemotherapy after failure of gefitinib.
We analyzed the clinical data and mutational studies of patients with NSCLC in the National Taiwan University Hospital who had received gefitinib and, after failure of gefitinib, cetuximab-containing chemotherapy.
Fifteen patients who received cetuximab-containing chemotherapy after failure of gefitinib were identified. Four were responders to gefitinib therapy, and 3 were responders to cetuximab-containing chemotherapy. Ten were sequenced for EGFR and KRAS mutations. Six of the 10 patients had EGFR mutations, and all 10 patients had wild-type (WT) KRAS. In the 4 patients who had the gefitinib-resistant EGFR T790M mutation, 2 were responders to cetuximab-containing chemotherapy. The other cetuximab responder had WT EGFR.
Cetuximab might add benefit in treatment after failure of gefitinib, regardless of EGFR mutational status. Treatment with cetuximab should be further explored, even in patients who have previously received gefitinib treatment.
吉非替尼和西妥昔单抗都是表皮生长因子受体（EGFR）靶向治疗药物，用于治疗具有不同机制的非小细胞肺癌（NSCLC）患者。为了阐明吉非替尼治疗失败后西妥昔单抗的疗效，我们研究了在吉非替尼治疗失败后接受西妥昔单抗联合化疗的 NSCLC 患者的临床特征。
我们分析了在台湾大学医院接受吉非替尼治疗且在吉非替尼治疗失败后接受西妥昔单抗联合化疗的 NSCLC 患者的临床数据和突变研究。
确定了 15 例在吉非替尼治疗失败后接受西妥昔单抗联合化疗的患者。4 例对吉非替尼治疗有反应，3 例对西妥昔单抗联合化疗有反应。10 例进行了 EGFR 和 KRAS 突变测序。10 例患者中有 6 例存在 EGFR 突变，所有患者均为 WT KRAS。在 4 例 EGFR T790M 突变的吉非替尼耐药患者中，2 例对西妥昔单抗联合化疗有反应。另一位西妥昔单抗应答者具有 WT EGFR。
西妥昔单抗可能在吉非替尼治疗失败后增加治疗效果，而与 EGFR 突变状态无关。即使在先前接受过吉非替尼治疗的患者中，也应进一步探索西妥昔单抗的治疗。
