|化疗优于EGFR TKI?中国晚期NSCLC EGFR 20外显子插入突变患者的真实世界治疗结果-MedSci.cn - 梅斯(MedSci)
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ASCO2019 |化疗优于EGFR TKI?中国晚期NSCLC EGFR 20外显子插入突变患者的真实世界治疗结果

2019-06-04 小M MedSci原创

第55届美国临床肿瘤学会(ASCO)年会于2019年5月31日至6月4日在美国芝加哥召开。本次会议吸引世界3万8千名肿瘤专家参与。

第55届美国临床肿瘤学会(ASCO)年会于2019年5月31日至6月4日在美国芝加哥召开。本次会议吸引世界3万8千名肿瘤专家参与。

会上展示了中国晚期NSCLC EGFR 20外显子插入突变患者的真实世界治疗结果。这项研究的结果令人吃惊,对于EGFR ex20ins患者,化疗的治疗效果竟比EGFR TKI更优。

我们采访了负责人之一杨广建医生,杨医生称这一研究隶属“回顾性国内多中心肺癌的真实世界研究”课题,主要是寻求在少见基因型突变的中国晚期非小细胞肺癌患者的治疗突破。因为特定基因突变的患者人数少,很难实现临床III期试验,研究团队巧妙地通过社交媒体收集数据,实现了真实世界汇集少数特定基因突变的患者的目的。

背景
晚期EGFR外显子20插入(ex20ins)患者接受一线或二线化疗和EGFR TKIs的治疗结果仍然有限。

方法
通过在线患者登记表和医院的数据,对临床、分子分型和治疗结果进行回顾性真实世界分析。

结果
从2018年9月13日到2018年10月22日,对中国26个不同地区的99家医院接受治疗的NSCLC患者进行了登记,数据截至截止日期为2018年12月20日。



通过商业NGS(84%)或PCR(16%)测定EGFR ex20ins,鉴定了41种不同的EGFR ex20ins分子亚型。 其中Ala767_Val769dupASV 最常见(23.0%),其次是Ser768_Asp770dupSVD(17.6%)。61%的患者为女性,77%的患者从不吸烟。诊断期间有22.4%的患者发生中枢神经系统疾病(CNS)。

接受一线铂类化疗(N = 105) (6.4m; 95% CI:5.7-7.1)与使用EGFR TKIs(所有代,N = 23)(2.9m; 95%CI:1.5-4.3; P <0.001)或EGFR TKI(第一代,N = 14)(2.6m; 95%CI:0.8-4.4; P <0.001)的患者相比,中位PFS显著延长。

接受二线紫杉醇化疗(N = 34)(4.1m; 95%CI:3.3-4.9)的患者与接受二线EGFR TKIs(N = 18)(2.0m; 95%CI:0.8-3.2; P = 0.342)的患者相比,PFS中位数更长。

在接受一线化疗的患者中,具有CNS的患者(N = 21)PFS中位数比没有CNS的患者(N = 84)短4) (5.5m; 95%CI:0.7-10.3 vs. 6.4m; 95%CI:5.8-7.0; P = 0.694)。

接受一线EGFR TKI治疗的有CNS患者(N = 7)中位数PFS数值短于没有CNS患者(N = 16)6) (2.0m; 95%CI:0.8-3.2 vs. 2.9m; 95%CI:2.1-3.7; P = 0.077)。


结论
对于EGFR ex20ins患者,化疗优于目前批准的EGFR TKIs一线或二线治疗。有CNS 的患者在化疗和EGFR TKI治疗中的PFS数值较差。因此需要针对具有中枢神经系统疾病的EGFR ex20ins患者开展靶向治疗。

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    2019-09-30 quxin068
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    2019-06-06 lsj628
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    2019-06-06 liuyiping
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    2019-06-04 肿肿

    NSCLC下一步突破在于新靶点了,靶向治疗和免疫治疗基本见顶了,再有新的就需要新机制了

    0

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