Chen Dan, Song Zhengbo, Cheng Guoping
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing.
Department of Chemotherapy.
Onco Targets Ther. 2016 Jul 8;9:4181-6. doi: 10.2147/OTT.S108242. eCollection 2016.
Subsets of non-small-cell lung cancer patients with epidermal growth factor receptor (EGFR) mutations carry uncommon subtypes. We evaluated the efficacy of first-generation EGFR-tyrosine kinase inhibitors (TKIs; erlotinib, gefitinib, and icotinib) in patients with non-small-cell lung cancer carrying insertions and T790M and S768I mutations in EGFR exon 20.
Patients carrying EGFR exon 20 insertion/T790M/S768I mutations and treated with EGFR-TKIs were evaluated from 2005 to 2014 in Zhejiang Cancer Hospital. The efficacy was evaluated using the Kaplan-Meier method and compared with the log-rank test.
Sixty-two patients with exon 20 insertion/T790M/S768I mutations were enrolled. Mutations including exon 20 insertions and T790M and S768I mutations were observed in 29, 23, and ten patients, respectively. In total, the response rate and median progression-free survival (PFS) were 8.1% and 2.1 months, respectively. Patients with S768I mutation manifested the longest median PFS (2.7 months), followed by those with T790M (2.4 months) and exon 20 insertions (1.9 months; P=0.022). Patients with complex mutations show a better PFS than those with single mutations (2.7 months vs 1.9 months; P=0.034).
First-generation EGFR-TKIs are less effective in patients with exon 20 uncommon mutations than in those with common mutations. Patients with complex mutations benefited more from first-generation EGFR-TKIs than those with single mutations.
携带表皮生长因子受体（EGFR）突变的非小细胞肺癌患者亚组具有不常见的亚型。我们评估了第一代EGFR酪氨酸激酶抑制剂（TKIs；厄洛替尼、吉非替尼和埃克替尼）对携带EGFR外显子20插入、T790M和S768I突变的非小细胞肺癌患者的疗效。
2005年至2014年在浙江省肿瘤医院对携带EGFR外显子20插入/T790M/S768I突变并接受EGFR-TKIs治疗的患者进行了评估。使用Kaplan-Meier方法评估疗效，并与对数秩检验进行比较。
纳入了62例具有外显子20插入/T790M/S768I突变的患者。分别在29例、23例和10例患者中观察到包括外显子20插入以及T790M和S768I突变在内的突变。总体而言，缓解率和中位无进展生存期（PFS）分别为8.1%和2.1个月。S768I突变患者的中位PFS最长（2.7个月），其次是T790M突变患者（2.4个月）和外显子20插入患者（1.9个月；P=0.022）。复合突变患者的PFS优于单突变患者（2.7个月对1.9个月；P=0.034）。
第一代EGFR-TKIs对具有外显子20罕见突变的患者的疗效低于对具有常见突变的患者。复合突变患者比单突变患者从第一代EGFR-TKIs中获益更多。
