Pemetrexed-based chemotherapy for non-small-cell lung cancer patients with EGFR exon 20 insertion mutation: a multicenter study

被引：25

作者：

Xu, Chun-Wei ^{[1
]}

Wang, Wen-Xian ^{[2
]}

Wang, Dong ^{[1
]}

Wang, Qi-Ming ^{[3
]}

Pu, Xing-Xiang ^{[4
]}

Zhu, You-Cai ^{[5
]}

Huang, Jian-Hui ^{[6
]}

Yu, Zong-Yang ^{[7
]}

Cui, Zhao-Lei ^{[8
,9
]}

Chen, Xiao-Hui ^{[10
,11
]}

Li, Jin-Luan ^{[12
]}

Fang, Yong ^{[13
]}

Wang, Hong ^{[14
]}

Zhuang, Wu ^{[15
]}

Lan, Shi-Jie ^{[16
]}

Cai, Xin ^{[17
]}

Zhang, Yin-Bin ^{[18
]}

Gao, Wen-Bin ^{[19
]}

Wang, Li-Ping ^{[20
]}

She, Ke-Lin ^{[21
]}

Rao, Chuang-Zhou ^{[22
]}

Zhou, Yue-Fen ^{[6
]}

Fang, Mei-Yu ^{[2
]}

Miao, Li-Yun ^{[23
]}

Lei, Lei ^{[2
]}

Lv, Tang-Feng ^{[1
]}

Song, Yong ^{[1
]}

机构：

[1] Nanjing Univ, Affiliated Jinling Hosp, Med Sch, Dept Resp Med, 305 Zhongshan Rd, Nanjing, Peoples R China

[2] Univ Canc Hosp, Zhejiang Canc Hosp, Chinese Acad Sci, Dept Med Oncol, 1 Banshan East St, Hangzhou, Peoples R China

[3] Zhengzhou Univ, Affiliated Canc Hosp, Henan Canc Hosp, Dept Internal Med, Zhengzhou, Peoples R China

[4] Cent South Univ, Hunan Canc Hosp, Affiliated Canc Hosp, Xiangya Sch Med,Dept Med Oncol, Changsha, Peoples R China

[5] Zhejiang Rongjun Hosp, Dept Thorac Dis Ctr, Jiaxing, Peoples R China

[6] Lishui Municipal Cent Hosp, Dept Oncol, Lishui, Peoples R China

[7] Fujian Med Univ, Hosp 900, Fuzhou Gen Hosp, Dept Med Oncol,Joint Logist Team, Fuzhou, Peoples R China

[8] Fujian Canc Hosp, Dept Clin Lab, Fuzhou, Peoples R China

[9] Fujian Med Univ Canc Hosp, Dept Clin Lab, Fuzhou, Peoples R China

[10] Fujian Canc Hosp, Dept Thorac Surg, Fuzhou, Peoples R China

[11] Fujian Med Univ Canc Hosp, Dept Thorac Surg, Fuzhou, Peoples R China

[12] Xiamen Univ, Xiamen Canc Hosp, Affiliated Hosp 1, Dept Radiotherapy, Xiamen, Peoples R China

[13] Sir Run Run Shaw Hosp, Dept Oncol, Hangzhou, Peoples R China

[14] Gen PLA, Dept Lung Canc, Med Ctr 5, Beijing, Peoples R China

[15] Fujian Med Univ Canc Hosp, Fujian Canc Hosp, Dept Med Oncol, Fuzhou, Peoples R China

[16] First Hosp Jilin Univ, Dept Oncol, Changchun, Peoples R China

[17] Dalian Med Univ, Affiliated Hosp 1, Dept Oncol, Dalian, Peoples R China

[18] Xi An Jiao Tong Univ, Affiliated Hosp 2, Med Coll, Dept Oncol, Xian, Peoples R China

[19] Shenzhen Luohu Peoples Hosp, Dept Oncol, Shenzhen, Guangdong, Peoples R China

[20] Baotou Canc Hosp, Dept Oncol, Baotou, Peoples R China

[21] Cent Hosp Shaoyang City, Dept Thorac Surg, Shaoyang, Peoples R China

[22] Univ Chinese Acad Sci, Hwamei Hosp, Dept Radiat & Chemotherapy, Ningbo, Peoples R China

[23] Nanjing Univ, Med Sch, Dept Resp Med, Affiliated Drum Tower Hosp, 321 Zhongshan Rd, Nanjing, Peoples R China

来源：

TRANSLATIONAL LUNG CANCER RESEARCH | 2020年 / 9卷 / 05期

关键词：

Exon 20 insertion (ex20ins); non-small-cell lung cancer (NSCLC); chemotherapy; pemetrexed; ERLOTINIB; THERAPY;

D O I：

10.21037/tlcr-20-382

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: Chemotherapy is the major choice for advanced non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor exon 20 insertion (EGFR ex20ins). The efficacy of pemetrexed-based with other chemotherapy regimens and EGFR ex20ins subtypes in this population has not been well studied. Methods: We screened patients with EGFR ex20ins by next-generation sequencing (NGS) from a large cohort. The clinicopathologic and medical information were collected in advanced NSCLC patients with EGFR ex20ins. We also compared the clinical outcomes among patients with different subtypes of EGFR ex20ins. Results: We retrospectively collected 119 stage IIIB/IV NSCLC patients with EGFR ex20ins from 9142 NSCLC patients across China from June 2013 to December 2018. The subtypes of EGFR ex20ins included A767_V769dupASV (33/119, 27.73%), S768_D770dupSVD ( 19/119, 15.97%), N771_H773dupNPH (11/119, 9.24%), A763_Y764insFQEA (2/119, 1.68%) and others (54/119, 45.38%). A total of 64.7% (77/119) of patients received pemetrexed-based first-line chemotherapy and 13.45% (16/ 119) of patients received pemetrexed-based second-line chemotherapy. Pemetrexed-based chemo-treated patients had longer median progression-free survival (PFS) than patients without pemetrexed-based chemo-treated (5.5 vs. 3.0 months, P=0.0026). Survival data was available for 66 patients and the median overall survival (OS) was 24.7 months. Pemetrexed-based chemo-treated patients had longer OS tendency than patients without pemetrexed-based chemo-treated (25.0 vs. 19.6 months, P=0.0769). Patients harboring A767_V769dupASV had better OS than other subtypes of EGFR ex20ins but without statistical significance ( P=0.0676). Multivariate analysis revealed that histological type of NSCLC and bone-metastasis before treatment were independent prognostic factors for OS in all patients after adjusting all characteristic and treatment factors (P<0.05). Conclusions: To the best of our knowledge, it is the largest cohort study of advanced NSCLC patients with EGFR ex20ins across China. Pemetrexed-based treatment could have better control of disease than non-pemetrexed-based chemotherapies in this population. Furthermore, more effective agents are expected for patients harboring EGFR ex20ins.

引用

页码：1853 / 1861

页数：9

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