Zhu You-Cai, Zhang Xin-Gen, Lin Xue-Ping, Wang Wen-Xian, Li Xiao-Feng, Wu Li-Xin, Chen Hua-Fei, Xu Chun-Wei, Du Kai-Qi
Department of Thoracic Disease Center, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang 314000, P.R. China.
Department of Surgery, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang 314000, P.R. China.
Oncol Lett. 2019 Mar;17(3):3466-3474. doi: 10.3892/ol.2019.9949. Epub 2019 Jan 18.
C-ros oncogene 1 receptor tyrosine kinase () rearrangement forms a novel molecular subgroup of non-small cell lung cancer (NSCLC). The present study explored the clinicopathological features and clinical efficacy of crizotinib in patients with -positive NSCLC. A retrospective analysis of 2,617 cases of NSCLC diagnosed between January 2013 and December 2016 was performed. fusion genes were detected by reverse transcription-quantitative polymerase chain reaction, fluorescence hybridization or next-generation sequencing techniques, and patients positive for the fusion gene received oral treatment with crizotinib. The fusion was identified in 67 out of 2,617 cases (2.56%), including 21 cases that were male and 46 cases that were female. The median age was 68 years. Among these cases, 59 (88.06%) were adenocarcinoma and 8 were non-adenocarcinoma. According to Tumor-Node-Metastasis (TNM) staging, 4 cases were stage I-IIIa and 63 (94.02%) were stage IIIb-IV. The epidermal growth factor receptor gene status included 60 cases of wild-type, 1 case of co-mutation and 6 unknown cases. Statistically significant differences were identified for sex, TNM staging and gene status between fusion gene-positive and -negative patients (P<0.001). A total of 23 patients received oral treatment with crizotinib, of which 13 (56.52%), 5 (21.74%) and 5 (21.74%) patients demonstrated a partial response, stable disease and progressive disease, respectively. The objective response rate was 56.52% and the disease control rate was 78.26%. Among all patients, the median progression-free survival (mPFS) time was 14.5 months. No differences were revealed in the mPFS time with regard to age, sex, smoking history, performance status score, histopathological type, TNM staging, tumor protein p53 gene status, gene status and first-line crizotinib treatment, whether by single or multiple factor analysis. The grade 3/4 treatment-associated adverse events included gastrointestinal disturbance, followed by increased transaminase concentration. In conclusion, the rate of fusion in NSCLC among the patients is low, and crizotinib is an effective and safe drug for the treatment of -positive advanced NSCLC.
C-ros原癌基因1受体酪氨酸激酶()重排形成了非小细胞肺癌(NSCLC)的一个新分子亚组。本研究探讨了克唑替尼治疗阳性NSCLC患者的临床病理特征及临床疗效。对2013年1月至2016年12月间确诊的2617例NSCLC病例进行回顾性分析。采用逆转录定量聚合酶链反应、荧光杂交或下一代测序技术检测融合基因,融合基因阳性患者接受克唑替尼口服治疗。2617例病例中,67例(2.56%)检测到融合,其中男性21例,女性46例。中位年龄为68岁。这些病例中,59例(88.06%)为腺癌,8例为非腺癌。根据肿瘤-淋巴结-转移(TNM)分期,4例为Ⅰ-Ⅲa期,63例(94.02%)为Ⅲb-Ⅳ期。表皮生长因子受体基因状态包括60例野生型、1例共突变和6例未知病例。融合基因阳性和阴性患者在性别、TNM分期和基因状态方面存在统计学显著差异(P<0.001)。共有23例患者接受克唑替尼口服治疗,其中13例(56.52%)、5例(21.74%)和5例(21.74%)患者分别表现为部分缓解、疾病稳定和疾病进展。客观缓解率为56.52%,疾病控制率为78.26%。所有患者中,中位无进展生存期(mPFS)时间为14.5个月。无论单因素还是多因素分析,mPFS时间在年龄、性别、吸烟史、体能状态评分、组织病理学类型、TNM分期、肿瘤蛋白p53基因状态、基因状态和一线克唑替尼治疗方面均无差异。3/4级治疗相关不良事件包括胃肠道紊乱,其次是转氨酶浓度升高。总之,患者中NSCLC的融合率较低,克唑替尼是治疗阳性晚期NSCLC的一种有效且安全的药物。