Faehling Martin, Fallscheer Sabine, Schwenk Birgit, Seifarth Harald, Sträter Jörn, Lengerke Claudia, Christopoulos Petros
Clinic of Cardiology and Pneumology, Esslingen Hospital, 73730 Esslingen, Germany.
Clinic of Radiology, University of Münster, 48143 Münster, Germany.
Cancers (Basel). 2025 Apr 5;17(7):1237. doi: 10.3390/cancers17071237.
Treatment of lung adenocarcinoma has changed and now includes checkpoint inhibitors (CPIs) or, in the case of an mutation, third-generation EGFR TKI osimertinib. Few data compare the long-term overall survival (OS) of current and historic subgroups.
This real-world analysis (KOMPASS study) included stage IV lung-adenocarcinoma patients with either EGFR, KRAS, or no mutation. Patients were assigned to the "current" , , or no-mutation cohort if they had mutation testing using NGS ( = 199; median date of diagnosis 2021). If they had an EGFR PCR test only, they were assigned to the "historic" or no-mutation cohort ( = 127; median date of diagnosis 2014).
Both the current and the historic cohorts had significantly longer OS than the respective no-mutation cohorts (HR 0.58 and 0.60, respectively). The current no-mutation and cohorts had a strong trend to longer OS than the respective historic cohorts. In the no-mutation cohorts, the improvement was due to an increase in long-term survivors (HR 0.71), whereas in the mutation cohorts, the median OS was improved without long-term survivors (HR 0.70). The cohort showed OS like the no-mutation cohort, with a plateau of long-term survivors around 20%.
A comparison of our data with that of the phase III trials KEYNOTE-189 and FLAURA suggests that the improved outcomes are due to the use of CPIs or osimertinib. The clinical trial results are well translated into real-world clinical practice with comparable OS. patients benefit from CPI treatment like no-mutation patients.
肺腺癌的治疗方法已经发生了变化，现在包括检查点抑制剂（CPI），或者在存在特定突变的情况下，使用第三代表皮生长因子受体酪氨酸激酶抑制剂（EGFR TKI）奥希替尼。很少有数据比较当前和历史亚组的长期总生存期（OS）。
这项真实世界分析（KOMPASS研究）纳入了IV期肺腺癌患者，这些患者存在EGFR、KRAS突变或无突变。如果患者使用二代测序（NGS）进行了突变检测（n = 199；诊断中位日期为2021年），则被分配到“当前”EGFR突变、KRAS突变或无突变队列。如果他们仅进行了EGFR聚合酶链反应（PCR）检测，则被分配到“历史”EGFR突变或无突变队列（n = 127；诊断中位日期为2014年）。
当前和历史EGFR突变队列的总生存期均显著长于各自的无突变队列（风险比[HR]分别为0.58和0.60）。当前无突变和KRAS突变队列的总生存期有比各自历史队列更长的强烈趋势。在无突变队列中，生存期的改善归因于长期存活者数量的增加（HR 0.71），而在EGFR突变队列中，总生存期的中位数得到改善，但没有长期存活者（HR 0.70）。KRAS突变队列的总生存期与无突变队列相似，长期存活者比例稳定在20%左右。
将我们的数据与III期试验KEYNOTE-189和FLAURA的数据进行比较表明，预后改善归因于CPI或奥希替尼的使用。临床试验结果能够很好地转化为具有可比总生存期的真实世界临床实践。EGFR突变患者与无突变患者一样从CPI治疗中获益。
