Inomata Minehiko, Minatoyama Shuhei, Takata Naoki, Hayashi Kana, Hirai Takahiro, Seto Zenta, Tokui Kotaro, Taka Chihiro, Okazawa Seisuke, Kambara Kenta, Imanishi Shingo, Miwa Toshiro, Hayashi Ryuji, Matsui Shoko, Tobe Kazuyuki
First Department of Internal Medicine, Toyama University Hospital, Toyama, Toyama 930-0194, Japan.
Department of Medical Oncology, Toyama University Hospital, Toyama, Toyama 930-0194, Japan.
Mol Clin Oncol. 2024 May 1;20(6):43. doi: 10.3892/mco.2024.2741. eCollection 2024 Jun.
In epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) with negative or low programmed death ligand-1 (PD-L1) expression, the acquisition rate of the T790M mutation is higher after treatment with first-/second-generation EGFR-tyrosine kinase inhibitors (TKIs) and the progression-free survival (PFS) is longer in patients treated with osimertinib. The present study compared the clinical course after the initiation of each EGFR-TKI monotherapy in patients with EGFR-mutant NSCLC with negative or low PD-L1 expression. Data of patients with EGFR-mutant NSCLC with negative or low PD-L1 expression who were treated with EGFR-TKI monotherapy were retrieved and retrospectively analyzed. Between June 2013 and November 2023, 26 and 29 patients were treated with first-/second-generation EGFR-TKIs and osimertinib, respectively. The PFS time was longer in patients treated with osimertinib (median, 22.5 months) than in those treated with first-/second-generation EGFR-TKIs (median, 12.9 months). However, the EGFR-TKI treatment duration, defined as the PFS for osimertinib, or the sum of the PFS for first-/second-generation EGFR-TKIs and sequential osimertinib therapy after the acquisition of the T790M mutation, was similar between patients treated with first-/second-generation EGFR-TKIs (median, 23.0 months) and osimertinib (median, 22.5 months). The Cox proportional hazard model suggested that there was no significant difference in the EGFR-TKI treatment duration between patients treated with first-/second-generation EGFR-TKIs and patients treated with osimertinib (hazard ratio, 1.31, 95% CI, 0.55-3.13). In conclusion, first-/second-generation EGFR-TKIs and osimertinib were associated with a similar EGFR-TKI treatment duration in patients with EGFR-mutant NSCLC with negative or low PD-L1 expression. The findings suggested that both treatments are promising for this population.
在程序性死亡配体-1（PD-L1）表达阴性或低表达的表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）中，第一代/第二代EGFR酪氨酸激酶抑制剂（TKIs）治疗后T790M突变的获得率较高，而接受奥希替尼治疗的患者无进展生存期（PFS）更长。本研究比较了PD-L1表达阴性或低表达的EGFR突变型NSCLC患者开始每种EGFR-TKI单药治疗后的临床病程。检索并回顾性分析了接受EGFR-TKI单药治疗的PD-L1表达阴性或低表达的EGFR突变型NSCLC患者的数据。2013年6月至2023年11月期间，分别有26例和29例患者接受第一代/第二代EGFR-TKIs和奥希替尼治疗。接受奥希替尼治疗的患者的PFS时间（中位数为22.5个月）比接受第一代/第二代EGFR-TKIs治疗的患者（中位数为12.9个月）更长。然而，EGFR-TKI治疗持续时间，即奥希替尼的PFS，或第一代/第二代EGFR-TKIs的PFS与获得T790M突变后序贯奥希替尼治疗的PFS之和，在接受第一代/第二代EGFR-TKIs治疗的患者（中位数为23.0个月）和接受奥希替尼治疗的患者（中位数为22.5个月）之间相似。Cox比例风险模型表明，接受第一代/第二代EGFR-TKIs治疗的患者与接受奥希替尼治疗的患者在EGFR-TKI治疗持续时间上没有显著差异（风险比，1.31，95%CI，0.55-3.13）。总之，第一代/第二代EGFR-TKIs和奥希替尼在PD-L1表达阴性或低表达的EGFR突变型NSCLC患者中与相似的EGFR-TKI治疗持续时间相关。这些发现表明这两种治疗方法对该人群都有前景。
