摘要
目的:探讨二代测序(NGS)法在表皮生长因子受体(EGFR)突变的晚期非小细胞肺癌(NSCLC)患者一线使用EGFR-酪氨酸激酶抑制剂(TKIs)发生获得性耐药后续治疗选择中的指导作用。方法:回顾性分析2016年1月至2017年6月苏州大学附属第一医院收治的一线使用EGFR-TKIs发生获得性耐药的57例晚期NSCLC患者的临床资料。所有患者均行NGS法检测,分析获得性耐药的可能原因,并根据后续治疗方案分为靶向治疗组和化疗组,比较两组患者的无病进展生存时间(PFS)。结果:31例(54.4%)出现T790M突变,其中21例二线选择三代EGFR-TKIs奥希替尼治疗,10例选择二线化疗;2例(3.5%)出现EGFR外显子20插入突变,均选择二线化疗;9例(15.8%)合并ERBB2活化突变或扩增,其中仅1例二线选择二代EGFR-TKIs阿法替尼治疗,其余8例均选择二线化疗;另外合并MET扩增4例、合并KRAS突变4例、合并TP53突变4例、合并ALK重排1例、其他少见突变1例,合并基因全野生型1例,均选择二线化疗。靶向治疗组PFS为10.3个月,明显长于化疗组的6.4个月(P=0.000)。结论:一线使用一代EGFR-TKIs治疗的晚期NSCLC患者后续根据NGS法检测结果选择靶向治疗药物,可延长PFS。
Objective:To investigate the role of the new-generation sequencing(NGS)in the treatment of patients with advanced non-small cell lung cancer(NSCLC)who have epidermal growth factor receptor(EGFR)mutations.Methods:Clinic data form patients with advanced NSCLC who received acquired EGFR tyrosine kinase inhibitors(TKIs)treatment in our hospital from January2016to June2017were retrospective analyzed.The NGS method was used to analyze the possible causes of acquired drug resistance.Moreover,the patients were divided into molecular targeted therapy group and chemotherapy group according to the subsequent treatment options.The patient’s disease-free survival time(PFS)were compared.Results:31(54.4%)patients were with T790M mutations,21of whom chose osimertinib and10chose chemotherapy;2(3.5%)patients had EGFR exon20insertion mutation who all chose chemotherapy;9(15.8%)patients had ERBB2activating mutation or amplification,only one of whom chose afatinib as second-line therapy;and other4MET amplifications,4KRAS mutations,4TP53mutations,1ALK rearrangement,1other rare mutations were found,who all chose chemotherapy.The median PFS was10.3months in molecular targeted therapy group,which was significantly longer than that in chemotherapy group(6.4months)(P=0.000).Conclusion:The PFS of EGFR-mutant NSCLC patients was prolonged by using NGS detection,a method providing guidance on the options available for acquired resistance to EGFR TKI therapy.
作者
桂琦
徐澄澄
Gui Qi;Xu Chengcheng(Department of Oncology,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Thoracic Surgery,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)
出处
《广西医科大学学报》
CAS
2018年第12期1620-1623,共4页
Journal of Guangxi Medical University
基金
国家自然科学基金资助项目(No.81702254)
关键词
二代测序法
非小细胞肺癌
表皮生长因子受体-酪氨酸激酶抑制剂
获得性耐药
new-generation sequencing
non-small cell lung cancer
epidermal growth factor receptor-tyrosine kinase inhibitor
acquired resistance
