韩国非小细胞肺癌中罕见 EGFR 突变患者的一线阿法替尼治疗。
First-line Afatinib in Patients With Non-small-cell Lung Cancer With Uncommon EGFR Mutations in South Korea.
机构信息
Department of Internal Medicine, Pusan National University School of Medicine and Βiomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Internal Medicine, Ulsan University Asan Medical Center, Seoul, Republic of Korea.
出版信息
Anticancer Res. 2022 Mar;42(3):1615-1622. doi: 10.21873/anticanres.15636.
BACKGROUND/AIM: Non-small cell lung cancers (NSCLCs) harboring uncommon epidermal growth factor receptor (EGFR) mutations are heterogeneous and show variable prevalence and clinical responses to EGFR tyrosine kinase inhibitors. We investigated the characteristics of uncommon EGFR mutations and the clinical efficacy of afatinib in patients with NSCLC harboring uncommon EGFR mutations.
PATIENTS AND METHODS
In this multicenter, retrospective study, we analyzed patients with NSCLC with uncommon EGFR mutations in 16 South Korean institutes. Mutations were categorized according to their incidence: 1) major uncommon mutations (G719X and L861Q), 2) compound mutations, and 3) minor uncommon mutations (exon 20 insertion, S768I, and de novo T790M).
RESULTS
Of 703 patients with EGFR-mutant NSCLC, 64 (9.1%) had uncommon EGFR mutations. Afatinib demonstrated activity against tumors harboring major uncommon mutations [median time of treatment (TOT): 20.3 months, 95% confidence interval (CI)=15.1-25.5; overall survival (OS): 30.6 months, 95% CI=26.3-34.8] and compound mutations (median TOT: 12.3 months, 95% CI=7.7-17.0; OS: 29.1 months, 95% CI=20.4-37.7) but not against tumors harboring minor uncommon mutations (median TOT: 3.8 months, 95% CI=1.7-6.0; OS: 8.5 months, 95% CI=5.2-11.7). The S768I mutation was present in 14 patients (1.99%). The median TOT and OS were not significantly different between S768I mutations and resistant exon 20 mutations.
CONCLUSION
Afatinib is effective in patients with NSCLC harboring major uncommon and compound EGFR mutations.
背景/目的：非小细胞肺癌（NSCLC）中罕见的表皮生长因子受体（EGFR）突变具有异质性，并且对 EGFR 酪氨酸激酶抑制剂的反应存在不同的流行程度和临床反应。我们研究了罕见 EGFR 突变的特征以及阿法替尼在携带罕见 EGFR 突变的 NSCLC 患者中的临床疗效。
患者和方法
在这项多中心回顾性研究中，我们分析了韩国 16 家机构中患有 NSCLC 且携带罕见 EGFR 突变的患者。突变根据其发生率进行分类：1）主要罕见突变（G719X 和 L861Q），2）复合突变，和 3）次要罕见突变（外显子 20 插入、S768I 和新出现的 T790M）。
结果
在 703 名 EGFR 突变型 NSCLC 患者中，有 64 名（9.1%）患者携带罕见 EGFR 突变。阿法替尼对携带主要罕见突变的肿瘤显示出活性[中位治疗时间（TOT）：20.3 个月，95%置信区间（CI）=15.1-25.5；总生存期（OS）：30.6 个月，95%CI=26.3-34.8]和复合突变（中位 TOT：12.3 个月，95%CI=7.7-17.0；OS：29.1 个月，95%CI=20.4-37.7），但对携带次要罕见突变的肿瘤无效（中位 TOT：3.8 个月，95%CI=1.7-6.0；OS：8.5 个月，95%CI=5.2-11.7）。S768I 突变存在于 14 名患者（1.99%）中。S768I 突变与耐药性外显子 20 突变之间的中位 TOT 和 OS 无显著差异。
结论
阿法替尼对携带主要罕见和复合 EGFR 突变的 NSCLC 患者有效。
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