Panda Goutam Santosh, Noronha Vanita, Shah Darshit, John George, Chougule Anuradha, Patil Vijay, Kumar Rajiv, Menon Nandini, Singh Ajay, Chandrani Pratik, Mahajan Abhishek, Prabhash Kumar
Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Dr. E Borges Road, Parel, Mumbai 400012, India.
Ecancermedicalscience. 2022 May 6;16:1385. doi: 10.3332/ecancer.2022.1385. eCollection 2022.
Limited data exists for non-small cell lung cancer (NSCLC) patients harbouring T790M mutation.
NSCLC patients, with T790M, who registered at our institute between 01/03/2015 and 31/12/2019, were considered for retrospective analysis of treatment pattern and clinical outcomes, i.e., progression-free survival (PFS) and overall survival (OS).
Of 1,542 epidermal growth factor receptor ()-mutated patients, 40 (2.59%) had T790M. Most were male (27, 67.5%) and smokers (23, 57.5%). The commonest site of metastasis was the lungs (31, 77.5%), while 7 (17.5%) had central nervous system (CNS) involvement. Additional gene mutations and anaplastic lymphoma kinase (ALK) positivity were observed in 20 (50.0%) and 4 (10.0%) cases, respectively. The first-line systemic therapy and the number of patients receiving it were as follows: osimertinib by 14 (35.0%), first-generation tyrosine kinase inhibitors (TKIs) by 10 (25.0%), gefitinib + chemotherapy by 3 (7.5%), chemotherapy by 7 (17.5%) and gefitinib + bevacizumab by 2 (5%). One patient defaulted before starting any treatment. Hence, 39 were considered for survival analysis. The median PFS and OS for the entire cohort were 10.4 (95% CI = 7.6-19.7) months and 24.9 (95% CI = 15.7-NA) months, respectively. The median PFS for patients on osimertinib was 19.8 (95% CI = 11.6-28.0) months versus 8.8 (95% CI = 6.6-10.9) months for those on other systemic therapy. No CNS involvement, use of osimertinib or first-generation TKI plus chemotherapy or ALK inhibitor in ALK-positive cases prognosticated better PFS. When compared to other systemic therapies, osimertinib improved PFS in patients with or without additional mutations, although it was statistically significant for the former group only ( = 0.002).
The incidence of T790M is low. Osimertinib in frontline therapy provides promising outcomes.
关于携带T790M突变的非小细胞肺癌（NSCLC）患者的数据有限。
对2015年3月1日至2019年12月31日期间在我院登记的携带T790M的NSCLC患者进行回顾性分析，以了解治疗模式和临床结局，即无进展生存期（PFS）和总生存期（OS）。
在1542例表皮生长因子受体（EGFR）突变患者中，40例（2.59%）携带T790M。大多数为男性（27例，67.5%）且为吸烟者（23例，57.5%）。最常见的转移部位是肺部（31例，77.5%），而7例（17.5%）有中枢神经系统（CNS）受累。分别在20例（50.0%）和4例（10.0%）病例中观察到其他EGFR基因突变和间变性淋巴瘤激酶（ALK）阳性。一线全身治疗及其接受患者数量如下：奥希替尼14例（35.0%），第一代EGFR酪氨酸激酶抑制剂（TKIs）10例（25.0%），吉非替尼+化疗3例（7.5%），化疗7例（17.5%），吉非替尼+贝伐单抗2例（5%）。1例患者在开始任何治疗前失访。因此，39例患者纳入生存分析。整个队列的中位PFS和OS分别为10.4（95%CI=7.6-19.7）个月和24.9（95%CI=15.7-无可用数据）个月。奥希替尼治疗患者的中位PFS为19.8（95%CI=11.6-28.0）个月，而接受其他全身治疗的患者为8.8（95%CI=6.6-10.9）个月。无CNS受累、使用奥希替尼或第一代EGFR TKI加化疗或ALK阳性病例中使用ALK抑制剂预示着更好的PFS。与其他全身治疗相比，奥希替尼改善了有或无其他EGFR突变患者的PFS，尽管仅对前一组具有统计学意义（P=0.002）。
T790M的发生率较低。一线治疗中使用奥希替尼可带来有前景的结果。
