Neoplasma. 2017;64(2):253-261. doi: 10.4149/neo_2017_212.
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have become a treatment after first-line chemotherapy in patients with advanced NSCLC. We assessed the predictive and prognostic role of EGFR and Kras mutations in NSCLC patients treated with TKIs after progression, not included in clinical trials. Gefitinib 250 mg or Erlotinib 150 mg per os were administered to 70 patients. Radiological assessment was performed every six weeks. EGFR and Kras mutations were found in 21.4% and 24.3% of patients, respectively. At multivariate analysis, Kras mutation was positively associated with progression-free survival (PFS; HR=0.71, 95% CI: 0.53-0.96; p=0.027) and, less clearly, with response (OR=1.84, 95% CI: 0.98-3.45; p=0.057) and survival (HR=0.74, 95% CI:0.54-1.02; p=0.066). EGFR mutation influenced positively PFS (HR=0.69, 95% CI: 0.47-1.02; p=0.06), but not survival. In conclusion, in our unselected patients mutation of Kras correlated with a better outcome. The small number of patients may explain some discrepancies with data in literature.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）已成为晚期 NSCLC 患者一线化疗后的治疗选择。我们评估了 EGFR 和 Kras 突变在未纳入临床试验的进展后接受 TKI 治疗的 NSCLC 患者中的预测和预后作用。给予 70 例患者吉非替尼 250 mg 或厄洛替尼 150 mg 口服。每 6 周进行一次影像学评估。分别在 21.4%和 24.3%的患者中发现了 EGFR 和 Kras 突变。多变量分析显示，Kras 突变与无进展生存期（PFS；HR=0.71，95%CI：0.53-0.96；p=0.027）呈正相关，与反应（OR=1.84，95%CI：0.98-3.45；p=0.057）和生存（HR=0.74，95%CI：0.54-1.02；p=0.066）的相关性较弱。EGFR 突变对 PFS 有积极影响（HR=0.69，95%CI：0.47-1.02；p=0.06），但对生存没有影响。总之，在我们未经选择的患者中，Kras 突变与更好的结果相关。患者人数较少可能解释了与文献数据的一些差异。
