[人表皮生长因子受体2（HER2）基因状态与培美曲塞联合铂类一线化疗治疗晚期肺腺癌患者疗效的相关性]
[Association between the HER2 Gene Status and the Efficacy of First-line Pemetrexed Combined with Platinum Chemotherapy in Patients with Advanced Lung Adenocarcinoma].
作者信息
Li Panhua, Li Banban, Shi Yunshu, Zhang Fengming, Shen Shujing, Li Xingya
机构信息
Department of Medical Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Department of Tumor Radiotherapy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
出版信息
Zhongguo Fei Ai Za Zhi. 2019 Mar 20;22(3):137-142. doi: 10.3779/j.issn.1009-3419.2019.03.03.
BACKGROUND
Human epidermal growth factor receptor 2 (HER2) is one of the driver genes of non-small cell lung cancer (NSCLC). Several studies have shown that the efficacy of pemetrexed in HER2-mutant NSCLC is controversial. The aim of this study is to investigate the efficacy of pemetrexed combined with platinum chemotherapy in patients with HER2-mutant and HER2 wild-type lung adenocarcinoma.
METHODS
The clinical data of 106 cases of EGFR, ALK, ROS-1, KRAS, BRAF, RET and MET-negative patients with advanced lung adenocarcinoma patients who diagnosed by histopathology in the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed. The relationships between HER2 gene status, clinical characteristics and response and progression-free survival (PFS) were analyzed.
RESULTS
All of the 106 patients' HER2 status were determined. HER2 mutations occurred in 32 cases (30.2%), no mutations in 74 cases (69.8%). HER2 mutations were common in young, non-smoking and female patients. All patients received first-line pemetrexed and platinum-based chemotherapy. The objective response rate (ORR) and disease control rate (DCR) of patients with HER2-mutant lung adenocarcinoma were significantly higher than those without HER2 mutations (40.6% vs 14.9%, χ²=8.464, P=0.004; 93.8% vs 68.9%, χ²=6.327, P=0.012), and the difference was statistically significant. According to univariate analysis, the PFS was significantly associated with the brain metastases, maintenance chemotherapy and HER2 gene status (P<0.05), but not with age, gender, smoking history, oligometastases, liver metastases and type of platinum (P>0.05). Cox multivariate analysis indicated that HER2 mutation was an independent positive prognostic factor of PFS (P=0.038).
CONCLUSIONS
HER2-mutant lung adenocarcinoma patients with first-line pemetrexed combined with platinum chemotherapy have greater clinical benefit than HER2 wild-type patients.
背景
人表皮生长因子受体2（HER2）是非小细胞肺癌（NSCLC）的驱动基因之一。多项研究表明培美曲塞在HER2突变型NSCLC中的疗效存在争议。本研究旨在探讨培美曲塞联合铂类化疗在HER2突变型和HER2野生型肺腺癌患者中的疗效。
方法
回顾性分析郑州大学第一附属医院经组织病理学诊断的106例EGFR、ALK、ROS-1、KRAS、BRAF、RET和MET阴性的晚期肺腺癌患者的临床资料。分析HER2基因状态、临床特征与反应及无进展生存期（PFS）之间的关系。
结果
确定了106例患者的HER2状态。32例（30.2%）发生HER2突变，74例（69.8%）无突变。HER2突变在年轻、不吸烟和女性患者中常见。所有患者均接受一线培美曲塞联合铂类化疗。HER2突变型肺腺癌患者的客观缓解率（ORR）和疾病控制率（DCR）显著高于无HER2突变患者（40.6%对14.9%，χ²=8.464，P=0.004；93.8%对68.9%，χ²=6.327，P=0.012），差异有统计学意义。单因素分析显示，PFS与脑转移、维持化疗及HER2基因状态显著相关（P<0.05），但与年龄、性别、吸烟史、寡转移、肝转移及铂类类型无关（P>0.05）。Cox多因素分析表明，HER2突变是PFS的独立阳性预后因素（P=0.038）。
结论
一线培美曲塞联合铂类化疗的HER2突变型肺腺癌患者比HER2野生型患者具有更大的临床获益。
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