Morsani College of Medicine, University of South Florida, United States.
Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, United States.
Cancer Treat Res Commun. 2021;28:100407. doi: 10.1016/j.ctarc.2021.100407. Epub 2021 May 26.
Within the exon 18 of EGFR, a complex, in-frame deletion-delE709_T710ins-has been described among pulmonary adenocarcinomas with an estimated prevalence of 0.3%. Available evidences suggest that some EGFR tyrosine kinase inhibitors (TKI) have activity against this cancer. However, due to the rarity of this mutation, it remains unclear which TKI is the most effective.
We reported our experience using afatinib followed by osimertinib in a patient with this mutation. We performed a systematic review of literature and conducted a pooled analysis to compare the outcomes of treatment with first generation TKIs vs. afatinib. Cases with compound mutations were excluded.
Our patient achieved a partial response to afatinib with a progression-free survival of 11 months. Upon disease progression, osimertinib failed to control the disease. Literature review identified 14 cases being reported: 8 received first generation TKI and 6 received afatinib. Among those with tumor response assessed, partial response occurred in 2 out of 7 patients (28.6%) treated with first generation TKI compared with 6 out of 6 patients (100%) treated with afatinib, p = 0.03. The median progression-free survival (PFS) was 3.1 months vs. 7.0 months, respectively, p = 0.005. Insufficient evidences were available to assess for the efficacy of osimertinib.
Based on currently available data, afatinib was associated with a greater tumor response rate and a longer PFS than the first generation TKIs.
在 EGFR 的外显子 18 中，已描述了一种复杂的、框内缺失-delE709_T710ins-h 的肺腺癌，其患病率估计为 0.3%。现有证据表明，一些 EGFR 酪氨酸激酶抑制剂（TKI）对此类癌症具有活性。然而，由于这种突变的罕见性，尚不清楚哪种 TKI 最有效。
我们报告了一名患有这种突变的患者使用阿法替尼后再使用奥希替尼的经验。我们对文献进行了系统回顾，并进行了荟萃分析，比较了第一代 TKI 与阿法替尼治疗的结果。排除了复合突变的病例。
我们的患者对阿法替尼有部分反应，无进展生存期为 11 个月。疾病进展后，奥希替尼未能控制病情。文献回顾确定了 14 例病例报告：8 例接受第一代 TKI 治疗，6 例接受阿法替尼治疗。在评估肿瘤反应的病例中，第一代 TKI 治疗的 7 例患者中有 2 例（28.6%）出现部分缓解，而阿法替尼治疗的 6 例患者中有 6 例（100%）出现部分缓解，p=0.03。中位无进展生存期（PFS）分别为 3.1 个月和 7.0 个月，p=0.005。尚无足够证据评估奥希替尼的疗效。
基于目前可用的数据，阿法替尼与第一代 TKI 相比，肿瘤反应率更高，无进展生存期更长。
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