埃克替尼对非小细胞肺癌EGFR 20外显子突变的临床疗效分析
| 作者: |
1庄武,
2陈燕坪,
1黄韵坚,
1黄章洲,
3朱有才,
3杜开齐,
4方美玉,
2王晓江,
2师怡,
2林贤东,
2许春伟,
2陈刚
1 福建医科大学附属福建省肿瘤医院胸部肿瘤内科，福州 350014 2 福建医科大学附属福建省肿瘤医院病理科，福州 350014 3 浙江省荣军医院胸外科，浙江 嘉兴 314000 4 浙江省肿瘤医院综合肿瘤内科，杭州 310022 |
| 通讯: |
方美玉
Email: fangjade2004@icloud.com 许春伟 Email: xuchunweibbb@163.com 陈刚 Email: naichengang@126.com |
| DOI: | 10.3978/j.issn.2095-6959.2017.02.011 |
| 基金: | 国家临床重点专科建设项目, 2013 福建省科技厅引导性项目, 2015Y0011 福建省科技厅引导性项目 浙江省卫生科研计划基金, 2013KYB051 浙江省中医药局科研基金, 2013ZQ005 |
摘要
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。
关键词：
非小细胞肺癌
埃克替尼
20外显子
Clinical efficacy of icotinib in patients with advanced non-small cell lung cancer harboring EGFR exon 20 mutations
CorrespondingAuthor: FANG Meiyu Email: fangjade2004@icloud.com
DOI: 10.3978/j.issn.2095-6959.2017.02.011
Abstract
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.