Noronha Vanita, Choughule Anuradha, Patil Vijay M, Joshi Amit, Kumar Rajiv, Susan Joy Philip Deepa, Banavali Shripad, Dutt Amit, Prabhash Kumar
Department of Medical Oncology.
Department of Medical Oncology-Molecular Laboratory.
Onco Targets Ther. 2017 Jun 9;10:2903-2908. doi: 10.2147/OTT.S133245. eCollection 2017.
There are limited data available on the treatment and outcome of epidermal growth factor receptor (EGFR) exon 20-mutated lung cancer patients. Hence, we planned an analysis of the demographic details, clinical profile and survival of lung cancer patients with exon 20 mutations. We compared our results to patients with EGFR tyrosine kinase inhibitor (TKI)-sensitizing activating and EGFR/anaplastic lymphoma kinase (ALK)-negative mutations.
This was a retrospective analysis of lung cancer patients who were treated at our center between January 2010 and August 2014. We reviewed the results of EGFR mutation testing by real-time polymerase chain reaction and Sanger sequencing. We also reviewed the data relating to baseline demographics, clinical profile, patient treatment and outcome measures in terms of response and overall survival (OS).
A total of 580 patients fulfilled the selection criteria. In all, 227 (39.1%) patients had EGFR TKI-sensitizing activating mutations, 20 (3.4%) patients had exon 20 insertion mutations and 333 patients were EGFR/ALK mutation negative (57.5%). The median OS was 5 months (95% confidence interval [CI] 0.17-9.8 months) in exon 20 insertion mutations, 16.1 months (95% CI 12.8-19.5 months) in EGFR TKI-sensitizing activating mutations and 10 months (95% CI 7.9-12.1 months) in EGFR/ALK mutation-negative patients. The median OS was significantly better for the EGFR TKI-sensitizing activating mutation group (=0.000, log-rank test) and for the EGFR/ALK-negative group (=0.037, log-rank test) compared to the exon 20-mutated group.
Exon 20 mutation results in a poorer OS prognosis compared to EGFR- and ALK-negative patients and patients harboring EGFR TKI-sensitizing activating mutations. The incidence of de novo exon 20 insertions was 3.4%. Different types of exon mutations seem to have different outcomes.
关于表皮生长因子受体（EGFR）外显子20突变的肺癌患者的治疗及预后的数据有限。因此，我们计划对具有外显子20突变的肺癌患者的人口统计学细节、临床特征及生存情况进行分析。我们将我们的结果与具有EGFR酪氨酸激酶抑制剂（TKI）敏感激活突变以及EGFR/间变性淋巴瘤激酶（ALK）阴性突变的患者进行比较。
这是一项对2010年1月至2014年8月期间在我们中心接受治疗的肺癌患者的回顾性分析。我们回顾了通过实时聚合酶链反应和桑格测序进行的EGFR突变检测结果。我们还回顾了与基线人口统计学、临床特征、患者治疗以及反应和总生存（OS）方面的结局指标相关的数据。
共有580例患者符合入选标准。其中，227例（39.1%）患者具有EGFR TKI敏感激活突变，20例（3.4%）患者具有外显子20插入突变，333例患者为EGFR/ALK突变阴性（57.5%）。外显子20插入突变患者的中位OS为5个月（95%置信区间[CI] 0.17 - 9.8个月），EGFR TKI敏感激活突变患者为16.1个月（95% CI 12.8 - 19.5个月），EGFR/ALK突变阴性患者为10个月（95% CI 7.9 - 12.1个月）。与外显子20突变组相比，EGFR TKI敏感激活突变组（对数秩检验，=0.000）和EGFR/ALK阴性组（对数秩检验，=0.037）的中位OS明显更好。
与EGFR和ALK阴性患者以及具有EGFR TKI敏感激活突变的患者相比，外显子20突变导致更差的OS预后。新发外显子20插入的发生率为3.4%。不同类型的外显子突变似乎具有不同的结局。
