Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 China; Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China.
Department of Medical Oncology, Qinghai Provincial People's Hospital, Xining 810000, China.
Lung Cancer. 2024 Jun;192:107827. doi: 10.1016/j.lungcan.2024.107827. Epub 2024 May 21.
Non-small cell lung cancer (NSCLC) harboring ROS1 rearrangements is a molecular subset that exhibits favorable responses to tyrosine kinase inhibitor (TKI) treatment than chemotherapy. This study investigated real-world treatment patterns and survival outcomes among patients with ROS1-rearranged advanced NSCLC.
We conducted a retrospective analysis of patients with ROS1-rearranged advanced NSCLC treated in four different hospitals in China from August 2018 to March 2022. The study analyzed gene fusion distribution, resistance patterns, and survival outcomes.
ROS1 rearrangement occurs in 1.8 % (550/31,225) of our study cohort. CD74 was the most common ROS1 fusion partner, accounting for 45.8 %. Crizotinib was used in 73.9 % of patients in the first-line treatment, and an increased use of chemotherapy, ceritinib, and lorlatinib was seen in the second-line setting. Lung (43.2 %) and brain (27.6 %) were the most common sites of progression in first-line setting, while brain progression (39.2 %) was the most common site of progression in second-line. Median overall survival was 46 months (95 % confidence intervals: 39.6-52.4). First-line crizotinib use yielded significantly superior survival outcomes over chemotherapy in terms of progression-free (18.5 vs. 6.0; p < 0.001) and overall survival (49.8 vs. 37; p = 0.024). The choice of treatment in the latter line also had survival implications, wherein survival outcomes were better when first-line crizotinib was followed by sequential TKI therapy than first-line chemotherapy followed by TKI therapy.
Our study provided insights into the real-world treatment, drug resistance patterns, and survival outcomes among patients with ROS1-rearranged NSCLC. This information serves as a valuable reference for guiding the treatment of this molecular subset of NSCLC.
ROS1 重排的非小细胞肺癌（NSCLC）对酪氨酸激酶抑制剂（TKI）治疗的反应优于化疗，属于分子亚型。本研究旨在调查 ROS1 重排的晚期 NSCLC 患者的真实世界治疗模式和生存结局。
我们对 2018 年 8 月至 2022 年 3 月在中国 4 家不同医院接受治疗的 ROS1 重排的晚期 NSCLC 患者进行了回顾性分析。研究分析了基因融合分布、耐药模式和生存结局。
ROS1 重排在本研究队列的 31225 例患者中占 1.8%（550 例）。CD74 是最常见的 ROS1 融合伙伴，占 45.8%。克唑替尼在一线治疗中用于 73.9%的患者，二线治疗中化疗、塞瑞替尼和劳拉替尼的使用率增加。在一线治疗中，肺部（43.2%）和脑部（27.6%）是最常见的进展部位，而在二线治疗中，脑部进展（39.2%）是最常见的进展部位。中位总生存期为 46 个月（95%置信区间：39.6-52.4）。一线克唑替尼治疗的无进展生存期（18.5 个月比 6.0 个月；p<0.001）和总生存期（49.8 个月比 37 个月；p=0.024）均显著优于化疗。二线治疗的选择也与生存结局相关，一线克唑替尼序贯 TKI 治疗的生存结局优于一线化疗序贯 TKI 治疗。
本研究提供了 ROS1 重排 NSCLC 患者真实世界治疗、耐药模式和生存结局的见解，为指导这一 NSCLC 分子亚型的治疗提供了有价值的参考。
