Histologic transformation of epidermal growth factor receptor-mutated lung cancer
Histologic transformation of epidermal growth factor receptor-mutated lung cancer
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DOI：
10.1016/j.ejca.2022.02.006
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发表时间：
2022-03-09
影响因子：
8.4
通讯作者：
Yamamoto, Nobuyuki
中科院分区：
文献类型：
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作者：
Fujimoto, Daichi;Akamatsu, Hiroaki;Yamamoto, Nobuyuki
目的：本研究旨在确定伴有组织学转化（HT）的表皮生长因子受体（EGFR）突变肺癌的发病率和临床病程。患者和方法：我们对 2012 年至 2019 年间接受 EGFR 酪氨酸激酶抑制剂（TKI）治疗的晚期 EGFR 突变肺癌患者进行了一项多中心、回顾性队列研究。主要结局是 HT 的发生率。次要结局是 HT 患者的治疗效果。结果：总共 6356 名患者入组。在 2624 名患者中，获得 EGFR-TKI 耐药后通过再次活检证实了组织学类型。其中，74名患者患有HT（发生率：2.8%[95%置信区间：2.3%-3.5%]）。确认HT后接受EGFR-TKIs和一线治疗后的中位无进展生存期分别为10.4个月和4.4个月，在转化为高级别神经内分泌癌的患者和转化为另一种非小细胞肺癌亚型的患者之间没有显着差异。确认 HT 后的总生存期为 12.2 个月。 27 名患者接受了免疫检查点抑制剂治疗：在确认 HT 之前和之后分别有 6 名和 21 名患者接受了免疫检查点抑制剂。没有患者达到 1 年无进展生存期。确认 HT 后，免疫检查点抑制剂治疗后的中位无进展生存期为 1.6 个月。结论：对 EGFR-TKI 产生耐药性的 EGFR 突变患者中，约 3% 发生 HT。细胞毒药物可能对 HT 患者有效。然而，免疫检查点抑制剂对这些患者的治疗效果有限。鉴于 HT 的罕见性和缺乏前瞻性试验，我们的研究结果对于指导这些患者的治疗非常重要。 (C) 2022 Elsevier Ltd. 保留所有权利。
Purpose: This study aimed to determine the incidence and clinical course of epidermal growth factor receptor (EGFR)-mutated lung cancer with histologic transformation (HT).Patients and methods: We conducted a multicentre, retrospective, cohort study of patients with advanced EGFR-mutated lung cancer who received EGFR-tyrosine kinase inhibitors (TKIs) between 2012 and 2019. The primary outcome was the incidence of HT. The secondary outcome was treatment efficacy in patients with HT.Results: In total, 6356 patients were enrolled. In 2624 patients, the histological type was proven by rebiopsy after acquiring resistance to EGFR-TKIs. Among them, 74 patients had HT (incidence rate: 2.8% [95% confidence interval: 2.3%-3.5% ]). The median progression-free survival after EGFR-TKIs and first-line therapy after confirming HT was 10.4 and 4.4 months, respectively, which was not significantly different between patients with transformation to high-grade neuroendocrine carcinoma and those with transformation to another subtype of non-small cell lung cancer. Overall survival after confirming HT was 12.2 months. Twenty-seven patients received immune checkpoint inhibitors: 6 and 21 received immune checkpoint inhibitors before and after confirming HT, respectively. No patients achieved 1-year progression-free survival. The median progression-free survival after immune checkpoint inhibitor therapy after confirming HT was 1.6 months.Conclusion: HT occurred in approximately 3% of EGFR-mutated patients who developed resistance to EGFR-TKIs. Cytotoxic agents are likely to be effective in patients with HT. However, the therapeutic effectiveness of immune checkpoint inhibitors was limited in these patients. Given the rarity of HT and absence of prospective trials, our findings are important to inform the treatment of these patients. (C) 2022 Elsevier Ltd. All rights reserved.