目的：探讨埃克替尼对非小细胞肺癌(non-small cell lung cancer，NSCLC)EGFR 20外显子S768I/20-ins/T790M/V769M突变的临床疗效。方法：回顾性分析58例埃克替尼治疗EGFR 20外显子少见突变的NSCLC，服用至病情进展或出现不可耐受的毒副反应，并观察疗效。结果：58例S768I/20-ins/T790M/V769M突变患者中S768I突变20例，中位生存时间3.2个月，20-ins突变18例，中位生存时间1.6个月，T790M突变21例，中位生存时间1.6个月，V769M突变1例，生存时间3.2个月。S768I突变和V769M突变患者生存时间稍长。单纯突变与复合突变相比，复合突变中位生存时间更长(S768I突变2.2个月 vs. 3.3个月，P=0.174；T790M突变2.45个月 vs. 2.9个月，P=0.845)。结论：埃克替尼在EGFR基因20外显子少见突变的疗效上比传统敏感突变未见明显优势，但复合突变比单纯突变临床获益更多。
Clinical efficacy of icotinib in patients with advanced non-small cell lung cancer harboring EGFR exon 20 mutations
Objective: To investigate the efficacy of icotinib in patients with non-small cell lung cancer (NSCLC) that carrying S768I/20 insertions/T790M/V769M in EGFR exon 20. Methods: Fifty eight cases of EGFR 20 exon rare mutation NSCLC patients were retrospectively analyzed until the progress of the disease or the emergence of the side effects and clinical efficacy was observed after months of followed-up. Results: Fifty eight patients with S768I/20 insertion/T790M/V769M mutations were enrolled. Mutations including S768I, exon 20 insertions, T790M and V769M mutations were observed in 20, 18, 21 and 1 patients, respectively. Patients with S768I mutation or V769M mutation manifested the longest median PFS (3.2 months), followed by those with T790M (1.6 months) and exon 20 insertions (1.9 months). Patients with complex mutations showed a better PFS than those with single mutations (S768I mutations 2.2 vs. 3.3 months, P=0.174; T790M 2.45 vs. 2.9 months, P=0.845). Conclusion: Icotinib is less effective in patients with exon 20 uncommon mutations than in those with common mutations. Patients with complex mutations benefited more from icotinib than those with single mutations.