摘要
随着检测技术的发展,非小细胞肺癌患者(non-small cell lung cancer, NSCLC)伴原发表皮生长因子受体(epidermal growth factor receptor, EGFR)T790M突变的检出率不断增加,而针对原发EGFR T790M突变NSCLC的一线治疗尚无标准。本文中我们报道了3例晚期NSCLC伴EGFR敏感突变及原发T790M突变的治疗经验,3例患者一线初治均为阿美替尼联合贝伐珠单抗。其中,1例在治疗3个月后因出血风险停用贝伐珠单抗并于10个月后更换为奥希替尼;1例患者在治疗13个月后更换为奥希替尼并停用贝伐珠单抗。3例患者最佳疗效均达部分缓解(partial response,PR)。随访至2022年10月,2例患者一线治疗后进展,无进展生存期(progression-free survival, PFS)分别为11个月和7个月;1例患者治疗后持续反应,治疗时间已达19个月。2例患者基线伴有多发脑转移,一线治疗后颅内病灶最佳疗效均为PR,颅内PFS分别为14个月和未达到(16+个月)。3例患者在治疗期间未见新的不良反应,未发生3级以上不良反应。此外,我们总结了NSCLC伴原发EGFR T790M突变的研究进展。总之,阿美替尼联合贝伐珠单抗初始治疗晚期NSCLC伴原发EGFR T790M突变具有较高的客观缓解率(objective response rate, ORR)及颅内病灶的控制能力,可作为晚期NSCLC伴原发EGFR T790M突变的一线治疗。
With the development of sequencing technology,the detection rate of non-small cell lung cancer(NSCLC) with primary epidermal growth factor receptor(EGFR) T790M mutation is increasing.However,the first-line treatment for primary EGFR T790M-mutated NSCLC still lacks standard recommendations.Here,we reported three advanced NSCLC cases with EGFR-activating mutation and primary T790M mutation.The patients were initially treated with Aumolertinib combination with Bevacizumab;among which,one case was discontinued Bevacizumab due to bleeding risk after treatment for three months.Treatment was switched to Osimertinib after ten months of treatment.Another case switched to Osimertinib and discontinued Bevacizumab after thirteen months of treatment.The best effect response in all three cases was partial response(PR) after initial treatment.Two cases progressed after first-line treatment and progression-free survival(PFS) was eleven months and seven months respectively.The other one patient had persistent response after treatment,and the treatment duration has reached nineteen months.Two cases had multiple brain metastases before administration and the best response to intracranial lesions was PR.The intracranial PFS was fourteen months and not reached(16+months),respectively.There were no new adverse events(AEs),and no AEs of grade three or above were reported.In addition,we summarized the research progress of Osimertinib in the treatment of NSCLC with primary EGFR T790M mutation.In conclusion,Aumolertinib combined with Bevacizumab in the treatment of advanced NSCLC with primary EGFR T790M mutation has a high objective response rate(ORR) and control ability of intracranial lesions,which can be used as one of the initial options for first-line advanced NSCLC with primary EGFR T790M mutation.
作者
杨雪
孟凡路
钟殿胜
Xue YANG;Fanlu MENG;Diansheng ZHONG(Department of Medical Oncology,Tianjin Medical University General Hospital,Tianjin 300052,China)
出处
《中国肺癌杂志》
CAS
CSCD
北大核心
2023年第2期158-164,共7页
Chinese Journal of Lung Cancer
