The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.
Department of Clinical Trial, Zhejiang Cancer Hospital, Hangzhou, China.
Cancer Med. 2023 Aug;12(15):15903-15911. doi: 10.1002/cam4.6229. Epub 2023 Jun 12.
The efficacy of definite for non-small-cell lung cancer (NSCLC) with uncommon epidermal growth factor receptor (EGFR) mutations has been preliminarily demonstrated. However, there is a paucity of data with which to compare the efficacy and safety of second- and third-generation TKIs in patients with NSCLC carrying uncommon EGFR mutations.
We compared the efficacy and safety of second- and third-generation TKIs in all NSCLC patients in whom next-generation sequencing confirmed uncommon EGFR mutations, including G719X, S768I, and L861Q. The parameters analyzed included the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). The rate of treatment-related adverse events (AEs) reflected the safety of these TKIs.
Eighty-four NSCLC patients with uncommon EGFR mutations were enrolled between April 2016 and May 2022 at Zhejiang Cancer Hospital, including 63 treated with second-generation TKIs and 21 treated with third-generation TKIs. The ORR for all patients receiving TKIs was 47.6%, and the DCR was 86.9%. The median PFS for NSCLC patients with uncommon EGFR mutations receiving TKIs was 11.9 months and OS was 30.6 months. There was no significant difference in PFS after treatment with second- or third-generation TKIs (13.3 vs. 11.0 months, respectively, P = 0.910) or in OS (30.6 vs. 24.6 months, respectively P = 0.623). The third-generation TKIs showed no severe toxicity.
The efficacy of second- and third-generation TKIs for NSCLC with uncommon EGFR mutations does not differ, and so can be used to treat NSCLC patients with these mutations.
非小细胞肺癌（NSCLC）中罕见表皮生长因子受体（EGFR）突变的疗效已初步得到证实。然而，对于携带罕见 EGFR 突变的 NSCLC 患者，比较第二代和第三代 TKI 的疗效和安全性的数据却很少。
我们比较了所有经下一代测序证实携带罕见 EGFR 突变（包括 G719X、S768I 和 L861Q）的 NSCLC 患者中使用第二代和第三代 TKI 的疗效和安全性。分析的参数包括客观缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）和总生存期（OS）。治疗相关不良事件（AE）的发生率反映了这些 TKI 的安全性。
2016 年 4 月至 2022 年 5 月，浙江肿瘤医院共纳入 84 例携带罕见 EGFR 突变的 NSCLC 患者，其中 63 例接受第二代 TKI 治疗，21 例接受第三代 TKI 治疗。所有接受 TKI 治疗的患者的 ORR 为 47.6%，DCR 为 86.9%。接受 TKI 治疗的 NSCLC 患者罕见 EGFR 突变的中位 PFS 为 11.9 个月，OS 为 30.6 个月。第二代和第三代 TKI 治疗后的 PFS 无显著差异（分别为 13.3 个月和 11.0 个月，P=0.910），OS 也无显著差异（分别为 30.6 个月和 24.6 个月，P=0.623）。第三代 TKI 无严重毒性。
第二代和第三代 TKI 治疗 NSCLC 罕见 EGFR 突变的疗效无差异，因此可用于治疗携带这些突变的 NSCLC 患者。
