中国晚期 NSCLC 患者中 RET 融合与培美曲塞为基础化疗疗效的相关性：一项多中心回顾性研究。
Association Between RET Fusions and Efficacy of Pemetrexed-based Chemotherapy for Patients With Advanced NSCLC in China: A Multicenter Retrospective Study.
机构信息
Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai, China.
Department of Medical Oncology, Hunan Cancer Hospital, Hunan, China.
出版信息
Clin Lung Cancer. 2020 Sep;21(5):e349-e354. doi: 10.1016/j.cllc.2020.02.006. Epub 2020 Feb 10.
BACKGROUND
Rearranged during transfection (RET) proto-oncogene gene fusions are rare in non-small-cell lung cancer (NSCLC). We compared the efficacy of pemetrexed-based chemotherapy with other chemotherapy regimens in patients with NSCLC with different RET fusion subtypes.
PATIENTS AND METHODS
A retrospective, multicenter study of patients with pathologically confirmed stage IIIB/IV lung adenocarcinomas was conducted. RET rearrangements were detected using next generation sequencing. We analyzed the clinical characteristics of patients with RET-rearranged NSCLC and the efficacy of chemotherapy regimens. We also evaluated the efficacy between groups of patients with and without KIF5B-RET-rearranged lung cancer.
RESULTS
We evaluated 62 patients with NSCLC and RET rearrangements, including 41 with KIF5B-RET, 15 with CCDC6-RET, and 6 with other rare fusion subtypes. Of these 62 patients, 50 had stage IIIB/IV. We also evaluated 40 patients with first-line chemotherapy information available. The median progression-free survival was significantly different between those receiving pemetrexed-based chemotherapy and those receiving other chemotherapy regimens (9.2 vs. 5.2 months; P = .007). The median progression-free survival for patients with KIF5B-RET fusion and non-KIF5B-RET fusion was not significantly different statistically (7.8 vs. 11.2 months; P = .847). For second-line chemotherapy, a statistically significant difference was found between the chemotherapy regimens (4.9 vs. 2.8 months; P = .049). Survival follow-up data were available for 38 patients with advanced NSCLC. The median overall survival was 26.4 months. The overall survival of the patients with RET-rearranged NSCLC who had received pemetrexed-based chemotherapy versus no pemetrexed-based chemotherapy was 35.2 versus 22.6 months (P = .052). No difference in survival was observed between the patients with KIF5B-RET and non-KIF5B-RET rearrangements.
CONCLUSIONS
Pemetrexed-based treatment should be considered first when selecting the chemotherapy regimen for patients with NSCLC and RET rearrangements.
背景
重排期间的 RET 原癌基因融合在非小细胞肺癌（NSCLC）中较为罕见。我们比较了不同 RET 融合亚型的 NSCLC 患者接受培美曲塞为基础的化疗与其他化疗方案的疗效。
患者与方法
对经病理证实的 IIIB/IV 期肺腺癌患者进行回顾性、多中心研究。采用下一代测序检测 RET 重排。我们分析了 RET 重排型 NSCLC 患者的临床特征和化疗方案的疗效。我们还评估了有无 KIF5B-RET 重排的肺癌患者之间的疗效差异。
结果
我们评估了 62 例 NSCLC 伴 RET 重排患者，包括 41 例 KIF5B-RET、15 例 CCDC6-RET 和 6 例其他罕见融合亚型。这些患者中 50 例为 IIIB/IV 期。我们还评估了 40 例具有一线化疗信息的患者。接受培美曲塞为基础的化疗与接受其他化疗方案的患者中位无进展生存期有显著差异（9.2 个月 vs. 5.2 个月；P=0.007）。KIF5B-RET 融合与非 KIF5B-RET 融合患者的中位无进展生存期无统计学差异（7.8 个月 vs. 11.2 个月；P=0.847）。对于二线化疗，化疗方案之间存在统计学差异（4.9 个月 vs. 2.8 个月；P=0.049）。晚期 NSCLC 患者的生存随访数据可用于 38 例患者。中位总生存期为 26.4 个月。接受培美曲塞为基础化疗的 RET 重排 NSCLC 患者与未接受培美曲塞为基础化疗的患者总生存期分别为 35.2 个月和 22.6 个月（P=0.052）。KIF5B-RET 和非 KIF5B-RET 重排患者的生存无差异。
结论
在选择 NSCLC 伴 RET 重排患者的化疗方案时，应首先考虑培美曲塞为基础的治疗。
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