Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Lung Cancer. 2013 May;80(2):191-6. doi: 10.1016/j.lungcan.2013.01.009. Epub 2013 Feb 4.
Epidermal growth factor receptor (EGFR) mutation status is an important predictor of the efficacy of EGFR tyrosine kinase inhibitor (TKI) therapy in patients with non-small cell lung cancer (NSCLC). We evaluated the real impact of EGFR mutation status on chemotherapy patterns of NSCLC patients.
This is a retrospective cohort study of consecutive advanced NSCLC patients attended at the Samsung Medical Centre in Seoul, Korea, from January 2007 through July 2010. EGFR mutation was analyzed by direct sequencing testing.
Among 1164 patients treated during the study period, 166 (14.3%) were EGFR mutation positive, 275 (23.6%) were mutation negative, and 723 (62.1%) had mutation status unknown. Overall, 605 (52%) received TKI therapy as a first-, second-, or third-line therapy. The proportions of patients receiving TKI therapy among those with positive, negative and unknown EGFR mutation status were 88.0, 46.5, and 45.8%, respectively. After adjustment for other factors, patients with a positive EGFR mutation status (odds ratio [OR] 7.88, 95% CI 4.58, 13.57), and those who were female (OR 2.83, 95% CI 2.04, 3.92) or had poor performance status (OR 1.58, 95% CI 1.13, 2.22) were significantly more likely to receive TKI treatment. Furthermore, the temporal relationship between EGFR mutation reporting and initiation of TKI therapy significantly differed by EGFR mutation status.
EGFR mutation status significantly affected the chemotherapy patterns in advanced NSCLC. More widespread EGFR testing and the use of faster and more sensitive mutation tests will result in more timely and appropriate use of TKI therapy in advanced NSCLC.
表皮生长因子受体（EGFR）突变状态是预测非小细胞肺癌（NSCLC）患者接受 EGFR 酪氨酸激酶抑制剂（TKI）治疗疗效的重要指标。我们评估了 EGFR 突变状态对 NSCLC 患者化疗模式的实际影响。
这是一项回顾性队列研究，纳入了 2007 年 1 月至 2010 年 7 月期间在韩国首尔三星医疗中心就诊的连续晚期 NSCLC 患者。通过直接测序检测分析 EGFR 突变。
在研究期间接受治疗的 1164 例患者中，166 例（14.3%）EGFR 突变阳性，275 例（23.6%）突变阴性，723 例（62.1%）突变状态未知。总体而言，605 例（52%）接受 TKI 治疗作为一线、二线或三线治疗。EGFR 突变阳性、阴性和未知患者接受 TKI 治疗的比例分别为 88.0%、46.5%和 45.8%。调整其他因素后，EGFR 突变阳性患者（优势比[OR]7.88，95%可信区间[CI]4.58，13.57）和女性患者（OR 2.83，95% CI 2.04，3.92）或表现状态差的患者（OR 1.58，95% CI 1.13，2.22）更有可能接受 TKI 治疗。此外，EGFR 突变报告与 TKI 治疗开始之间的时间关系因 EGFR 突变状态而异。
EGFR 突变状态显著影响晚期 NSCLC 的化疗模式。更广泛的 EGFR 检测以及使用更快、更敏感的突变检测将导致晚期 NSCLC 中更及时和更恰当的 TKI 治疗。
