一项关于驱动基因阳性且PD-L1高表达的非小细胞肺癌患者病理特征及靶向治疗效果评估的真实世界研究
[A Real-world Study on the Assessment of Pathological Characteristics and Targeted Therapeutic Effect of Non-small Cell Lung Cancer Patients with Positive Driving Genes and High PD-L1 Expression].
作者信息
Zhang Hui, Yang Xinjie, Li Kun, Wang Jinghui, Lv Jialin, Li Xi, Zhang Xinyong, Qin Na, Zhang Quan, Wu Yuhua, Ma Li, Gai Fei, Hu Ying, Zhang Shucai
机构信息
Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.
Department of Pathology, Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China.
出版信息
Zhongguo Fei Ai Za Zhi. 2021 Feb 20;24(2):78-87. doi: 10.3779/j.issn.1009-3419.2021.104.02. Epub 2021 Jan 22.
BACKGROUND
Targeted therapy for patients with driver genes positive and immunotherapy for patients with driver gene-negative but high programmed death ligand 1 (PD-L1) expression are the standards of first-line treatment for patients with advanced non-small cell lung cancer (NSCLC). The treatment options for patients with driver gene positive and high PD-L1 expression are still worth exploring.
METHODS
The characteristics of 315 patients with NSCLC were identified to analyze the clinicopathological characteristics of patients with driver gene positive and high PD-L1 expression, and the efficacy of targeted therapy.
RESULTS
Among the 315 patients, the total positive rate of driver genes was 62.2%, and the high PD-L1 expression rate (≥50.0%) was 11.2%. The proportion of patients with driver gene positive and high PD-L1 expression was 10.7%. PD-L1 was highly expressed in patients with epidermal growth factor receptor (EGFR) mutation, KRAS mutation, ALK fusion, BRAF mutation, and MET 14 exon skip mutation, the proportions were 7.8% (11/141), 18.2% (4/22), and 23.1%, (3/13), 50.0% (2/4) and 100.0% (1/1) respectively. EGFR mutation positive with PD-L1 high expression was mainly in patients with stage IV lung adenocarcinoma. KRAS mutation positive with PD-L1 high expression was mainly in patients with a history of smoking. Among them, two patients were followed in detail for targeted therapy, who with ALK fusion-positive and PD-L1 high expression (90.0%), EGFR L858R mutation and PD-L1 high expression (70.0%) respectively. The total OS of the patients was 5 months, 2 months.
CONCLUSIONS
The high PD-L1 expression rate in NSCLC patients with different driver gene mutations was variable, which maybe correlated with distinct clinicopathological characteristics. Patients with sensitive mutations and high PD-L1 expression may be less benefit from targeted therapy and have poor prognosis.
背景
针对驱动基因阳性患者的靶向治疗以及针对驱动基因阴性但程序性死亡配体1（PD-L1）高表达患者的免疫治疗是晚期非小细胞肺癌（NSCLC）患者一线治疗的标准方案。驱动基因阳性且PD-L1高表达患者的治疗选择仍值得探索。
方法
确定315例NSCLC患者的特征，以分析驱动基因阳性且PD-L1高表达患者的临床病理特征及靶向治疗的疗效。
结果
315例患者中，驱动基因总阳性率为62.2%，PD-L1高表达率（≥50.0%）为11.2%。驱动基因阳性且PD-L1高表达患者的比例为10.7%。PD-L1在表皮生长因子受体（EGFR）突变、KRAS突变、ALK融合、BRAF突变和MET 14外显子跳跃突变患者中高表达，比例分别为7.8%（11/141）、18.2%（4/22）、23.1%（3/13）、50.0%（2/4）和100.0%（1/1）。EGFR突变阳性且PD-L1高表达主要见于IV期肺腺癌患者。KRAS突变阳性且PD-L1高表达主要见于有吸烟史患者。其中，对2例患者进行了详细的靶向治疗随访，分别为ALK融合阳性且PD-L1高表达（90.0%）、EGFR L858R突变且PD-L1高表达（70.0%）。患者的总生存期分别为5个月、2个月。
结论
不同驱动基因突变的NSCLC患者中PD-L1高表达率各异，这可能与不同的临床病理特征相关。具有敏感突变且PD-L1高表达的患者可能从靶向治疗中获益较少且预后较差。
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