Wang Kung-Yang, Chang Shih-Chieh, Wei Yu-Feng, Hung Jui-Chi, Chen Chung-Yu, Chang Cheng-Yu
Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
Division of Chest Medicine, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yi-Lan 260, Taiwan.
Curr Oncol. 2025 Mar 18;32(3):174. doi: 10.3390/curroncol32030174.
Lung cancer is the leading cause of cancer-related death in Taiwan. It is often associated with mutations in the epidermal growth factor receptor () gene, with common mutations accounting for approximately 85% of all -related cases. However, the remaining 15% are caused by uncommon mutations in , mainly insertions in exon 20 (about 4%). The response to EGFR tyrosine kinase inhibitors (TKIs) can vary markedly with exon 20 insertions. However, few prior large-scale studies have examined patients with these mutations.
This study combines the databases of several large hospitals in Taiwan to analyze the effects and clinical significance of rare EGFR mutations on responses to EGFR-TKIs, considering the changes in medication.
This study enrolled 38 patients with non-small-cell lung cancer and exon 20 insertions. It assessed the correlations of various predictors with progression-free survival (PFS) and overall survival (OS). It showed that among those with exon 20 insertions, the median PFS was 5.15 months, and OS reached 13 months. The median PFS was 5.4 months for afatinib, 5.7 months for chemotherapy, and 4.3 months for first-generation EGFR-TKIs.
EGFR-TKIs may be considered as an alternative treatment option for patients with exon 20 insertions in cases where the currently recommended therapies, such as chemotherapy with or without amivantamab, are either unavailable or intolerable. The potential use of afatinib for specific patients in this context depends on the precise characteristics of their mutation and remains to be determined.
肺癌是台湾癌症相关死亡的主要原因。它常与表皮生长因子受体（EGFR）基因突变相关，常见突变约占所有EGFR相关病例的85%。然而，其余15%是由EGFR的罕见突变引起的，主要是外显子20插入（约4%）。对EGFR酪氨酸激酶抑制剂（TKIs）的反应因外显子20插入而有显著差异。然而，此前很少有大规模研究对这些EGFR突变患者进行过检查。
本研究结合台湾几家大型医院的数据库，分析罕见EGFR突变对EGFR-TKIs反应的影响及临床意义，并考虑用药变化。
本研究纳入了38例非小细胞肺癌且有EGFR外显子20插入的患者。评估了各种预测因素与无进展生存期（PFS）和总生存期（OS）的相关性。结果显示，在有EGFR外显子20插入的患者中，中位PFS为5.15个月，OS达13个月。阿法替尼的中位PFS为5.4个月，化疗为5.7个月，第一代EGFR-TKIs为4.3个月。
在目前推荐的治疗方法（如含或不含阿美替尼的化疗）不可用或无法耐受的情况下，EGFR-TKIs可被视为EGFR外显子20插入患者的替代治疗选择。在这种情况下，阿法替尼对特定患者的潜在用途取决于其突变的精确特征，仍有待确定。
