摘要
背景与目的驱动基因突变阳性患者行靶向治疗,驱动基因阴性但程序性死亡配体1(programmed death-ligand 1,PD-L1)高表达患者行免疫抑制剂治疗,是晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者一线治疗的首选,但对于驱动基因阳性且PD-L1高表达患者的治疗选择仍值得探究。方法以315例NSCLC患者为研究对象,分析驱动基因阳性且PD-L1高表达患者的临床病理特征及靶向治疗疗效。结果本研究纳入的315例NSCLC患者中,驱动基因突变总阳性率为62.2%,PD-L1高表达率(≥50.0%)为11.2%,驱动基因阳性且PD-L1高表达的患者比例为10.7%。其中表皮生长因子受体(epidermal growth factor receptor,EGFR)突变、KRAS突变、ALK融合、BRAF突变和MET 14外显子跳跃突变患者中均有PD-L1高表达,比例分别为7.8%(11/141)、18.2%(4/22)、23.1%(3/13)、50.0%(2/4)和100.0%(1/1)。EGFR突变且PD-L1高表达患者主要为IV期肺腺癌患者,KRAS突变且PD-L1高表达患者主要为有吸烟史的患者。其中详细跟踪了两例分别为ALK融合阳性且PD-L1高表达(90.0%)和EGFR L858R突变且PD-L1高表达(70.0%)患者的靶向治疗全过程,两例患者总生存期分别仅为5个月和2个月。结论NSCLC患者各驱动基因突变与PD-L1高表达共存的比例和临床病理特征有较大差异。发生敏感突变且PD-L1高表达的患者靶向治疗疗效和预后可能更差。
Background and objective Targeted therapy for patients with driver genes positive and immunotherapy for patients with driver gene-negative but high programmed death ligand 1(PD-L1)expression are the standards of firstline treatment for patients with advanced non-small cell lung cancer(NSCLC).The treatment options for patients with driver gene positive and high PD-L1 expression are still worth exploring.Methods The characteristics of 315 patients with NSCLC were identified to analyze the clinicopathological characteristics of patients with driver gene positive and high PD-L1 expression,and the efficacy of targeted therapy.Results Among the 315 patients,the total positive rate of driver genes was 62.2%,and the high PD-L1 expression rate(≥50.0%)was 11.2%.The proportion of patients with driver gene positive and high PD-L1 expression was 10.7%.PD-L1 was highly expressed in patients with epidermal growth factor receptor(EGFR)mutation,KRAS mutation,ALK fusion,BRAF mutation,and MET 14 exon skip mutation,the proportions were 7.8%(11/141),18.2%(4/22),and 23.1%,(3/13),50.0%(2/4)and 100.0%(1/1)respectively.EGFR mutation positive with PD-L1 high expression was mainly in patients with stage IV lung adenocarcinoma.KRAS mutation positive with PD-L1 high expression was mainly in patients with a history of smoking.Among them,two patients were followed in detail for targeted therapy,who with ALK fusionpositive and PD-L1 high expression(90.0%),EGFR L858 R mutation and PD-L1 high expression(70.0%)respectively.The total OS of the patients was 5 months,2 months.Conclusion The high PD-L1 expression rate in NSCLC patients with different driver gene mutations was variable,which maybe correlated with distinct clinicopathological characteristics.Patients with sensitive mutations and high PD-L1 expression may be less benefit from targeted therapy and have poor prognosis.
作者
张卉
杨新杰
李琨
王敬慧
吕嘉林
李曦
张新勇
秦娜
张权
吴羽华
马丽
盖飞
胡瑛
张树才
Hui ZHANG;Xinjie YANG;Kun LI;Jinghui WANG;Jialin LV;Xi LI;Xinyong ZHANG;Na QIN;Quan ZHANG;Yuhua WU;Li MA;Fei GAI;Ying HU;Shucai ZHANG(Department of Medical Oncology,Beijing Chest Hospital,Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institutej Beijing 101149,China;Department of Pathology,Beijing Chest Hospital Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China;Amoy Diagnostics Co.,Ltd,Xiamen 361000,China)
出处
《中国肺癌杂志》
CAS
CSCD
北大核心
2021年第2期78-87,共10页
Chinese Journal of Lung Cancer
关键词
肺肿瘤
驱动基因
程序性死亡配体1
靶向治疗
Lung neoplasms
Driver mutation
Programmed death-ligand 1
Targeted treatment