表皮生长因子受体酪氨酸激酶抑制剂治疗进展后的患者中表皮生长因子受体突变检测与治疗决策。
EGFR mutation testing and treatment decisions in patients progressing on first- or second-generation epidermal growth factor receptor tyrosine kinase inhibitors.
机构信息
Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
AstraZeneca US, 950 Wind River Ln, Gaithersburg, MD, 20878, USA.
出版信息
BMC Cancer. 2020 Apr 28;20(1):356. doi: 10.1186/s12885-020-06826-0.
BACKGROUND
The objective of this study was to investigate real-world EGFR mutation testing in patients with metastatic non-small cell lung cancer (NSCLC) upon progression on first-/second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI), and subsequent treatments received.
METHODS
Flatiron Health electronic health records-derived database was used to identify adult patients with metastatic NSCLC treated with first-/second-generation EGFR-TKI from 11/2015-09/2017, with start of first EGFR-TKI defined as the index date. Patients were stratified by receipt of EGFR-TKI as first-line (1 L) or later-line (2 L+) treatment. Mutation testing and subsequent therapies following first-/second-generation EGFR-TKI were described.
RESULTS
Overall, 782 patients (1 L = 435; 2 L+ =347) were included. Median age was 69.0 years, 63.6% were female, 56.3% were white, 87.1% were treated in community-based practices, and 30.1% of patients died during the study period; median follow-up was 309.0 days. Among the 294 (1 L = 160; 2L+ =134) patients who received subsequent therapies, treatments included chemotherapy only (1 L = 15.6%; 2L+ =21.6%), immunotherapy only (1 L = 13.8%; 2 L+ =41.0%), and targeted therapies (1 L = 70.0%; 2 L+ =36.6%). Specifically, 40 (25.0%) 1 L patients and 7 (5.2%) 2 L+ patients received osimertinib as subsequent therapy. Before the start of subsequent therapy, EGFR T790M resistance mutation testing was performed in 88 (29.9%) patients (1 L = 63 [39.4%]; 2 L+ =25 [18.7%]). Of these patients, 25 (28.4%) were T790M positive, among whom 24 (96.0%) received osimertinib.
CONCLUSIONS
A third of patients received subsequent therapies on disease progression; only 30% of these were tested for EGFR-TKI resistance mutation, prior to receiving subsequent therapies. These results highlight the importance of choosing treatments in the 1 L setting that optimize benefits for patients with EGFR-mutated NSCLC.
背景
本研究旨在调查第一代/第二代表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）治疗转移性非小细胞肺癌（NSCLC）进展后，真实世界中 EGFR 突变检测情况，以及随后接受的治疗。
方法
利用 Flatiron Health 电子病历数据库，从 2015 年 11 月至 2017 年 9 月，识别接受第一代/第二代 EGFR-TKI 治疗的转移性 NSCLC 成年患者，以开始使用第一代 EGFR-TKI 作为索引日期。根据接受 EGFR-TKI 作为一线（1L）或二线以上（2L+）治疗进行分层。描述了第一代/第二代 EGFR-TKI 后进行的突变检测和随后的治疗。
结果
共有 782 名患者（1L=435 例；2L+=347 例）入选。中位年龄为 69.0 岁，63.6%为女性，56.3%为白人，87.1%在社区实践中接受治疗，30.1%的患者在研究期间死亡；中位随访时间为 309.0 天。在 294 名（1L=160 例；2L+=134 例）接受后续治疗的患者中，治疗包括仅化疗（1L=15.6%；2L+=21.6%）、仅免疫治疗（1L=13.8%；2L+=41.0%）和靶向治疗（1L=70.0%；2L+=36.6%）。具体来说，40 名（25.0%）1L 患者和 7 名（5.2%）2L+患者接受奥希替尼作为后续治疗。在开始接受后续治疗之前，对 88 名（29.9%）患者进行了 EGFR T790M 耐药突变检测（1L=63[39.4%]；2L+=25[18.7%]）。其中 25 名（28.4%）患者 T790M 阳性，其中 24 名（96.0%）接受奥希替尼治疗。
结论
三分之一的患者在疾病进展时接受了后续治疗；在接受后续治疗之前，只有 30%的患者进行了 EGFR-TKI 耐药突变检测。这些结果强调了在 1L 治疗中选择能为 EGFR 突变 NSCLC 患者带来最大获益的治疗方案的重要性。
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