The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China; Department of Clinical Trial, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China; Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Department of Clinical Trial, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China; Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Ann Palliat Med. 2022 May;11(5):1624-1634. doi: 10.21037/apm-21-2828. Epub 2021 Dec 31.
This study aimed to explore the efficacy of different epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in lung adenocarcinoma (AC) patients harboring uncommon EGFR mutations.
Between January 1st, 2013 and October 1st, 2019, 2,680 EGFR mutation-positive patients with confirmed stage IIIB/IV lung AC were enrolled from Zhejiang Cancer Hospital. Uncommon EGFR mutations were detected in 132 patients using next-generation-sequencing. Clinicopathological features between patients with uncommon EGFR mutations and common EGFR mutations were evaluated by the chi-square test. The clinical outcomes of patients with uncommon EGFR mutations were analyzed by the Kaplan-Meier method.
Of 132 AC patients with uncommon EGFR mutations, 115 received EGFR-TKIs. Second-generation EGFR-TKIs were associated with longer progression-free survival (PFS) (P=0.116) and overall survival (OS) (P=0.005) than first or third-generation EGFR-TKIs. We also found that patients with compound mutations and double uncommon EGFR mutations had longer PFS (P=0.725) and OS (P=0.741) than those with single uncommon EGFR mutation, although the difference was not significant. In addition, third-generation EGFR-TKIs were more effective than the other two agents in patients with primary T790M mutation regarding PFS (P=0.150) and OS (P=0.033), although the difference in PFS was not significant.
Patients with uncommon EGFR mutations treated with second-generation EGFR-TKIs showed better PFS and OS. EGFR-TKIs were more effective in patients with compound mutations or double uncommon mutations.
本研究旨在探讨不同表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）在携带非常见 EGFR 突变的肺腺癌（AC）患者中的疗效。
2013 年 1 月 1 日至 2019 年 10 月 1 日期间，浙江肿瘤医院共纳入 2680 例经证实为 IIIB/IV 期肺 AC 的 EGFR 突变阳性患者。采用下一代测序法检测 132 例患者的非常见 EGFR 突变。采用卡方检验评估非常见 EGFR 突变患者与常见 EGFR 突变患者的临床病理特征。采用 Kaplan-Meier 法分析非常见 EGFR 突变患者的临床结局。
在 132 例非常见 EGFR 突变的 AC 患者中，115 例接受了 EGFR-TKIs 治疗。第二代 EGFR-TKIs 与更长的无进展生存期（PFS）（P=0.116）和总生存期（OS）（P=0.005）相关，优于第一代或第三代 EGFR-TKIs。我们还发现，与单种非常见 EGFR 突变相比，复合突变和双种非常见 EGFR 突变的患者 PFS（P=0.725）和 OS（P=0.741）更长，但差异无统计学意义。此外，对于原发性 T790M 突变的患者，第三代 EGFR-TKIs 在 PFS（P=0.150）和 OS（P=0.033）方面比其他两种药物更有效，尽管 PFS 方面的差异无统计学意义。
接受第二代 EGFR-TKIs 治疗的非常见 EGFR 突变患者 PFS 和 OS 更好。EGFR-TKIs 在复合突变或双种非常见突变患者中更有效。
