EGFR 20外显子插入突变晚期NSCLC化疗联合免疫治疗对比联合贝伐珠单抗临床分析

Clinical analysis of chemotherapy combined with immunotherapy versus with bevacizumab in treatment of advanced NSCLC with EGFR 20exon insertion mutations

目的 回顾性分析表皮生长因子受体(EGFR)20外显子插入突变的非小细胞肺癌(NSCLC)患者接受化疗联合免疫治疗或联合贝伐珠单抗的疗效和安全性,并对其远期生存的影响因素进行分析,为指导临床提供依据。方法 回顾性分析2016-01-01-2020-12-31就诊于山东省肿瘤医院(42例)、临沂市肿瘤医院(13例)和费县人民医院(5例)EGFR 20外显子插入突变的晚期NSCLC患者共60例,其中男27例,女33例;<65岁的患者45例,≥65岁患者15例。比较接受化疗联合免疫治疗(免疫组,n=29)和联合贝伐珠单抗(贝伐组,n=31)患者的治疗效果,包括客观缓解率(ORR)、疾病控制率(DCR)、无进展生存时间(PFS)、总生存期(OS)和药物不良反应发生情况。结果 60例患者PFS为9.7个月,免疫组患者PFS(13.0个月vs 8.3个月,P=0.044)和ORR(69.0%vs 41.9%,P=0.035)均高于贝伐组。脑转移患者中,贝伐组PFS(13.4个月)优于免疫组(10.5个月),P=0.047;吸烟患者中,免疫组PFS(10.0个月)优于贝伐组(7.2个月),P=0.044。药物不良反应多为胃肠道反应和骨髓抑制,两组差异无统计学意义(均P>0.05),而免疫组患者发热的发生率高于贝伐组,P=0.049。60例患者OS为21.7个月,吸烟(P=0.013)和脑转移(P=0.023)是影响OS的独立危险因素。结论 EGFR 20外显子插入突变NSCLC患者免疫组的ORR和PFS均显著优于贝伐组,但发热的发生率会增高。脑转移患者贝伐组治疗效果更好;吸烟患者免疫组治疗效果更好。生存期方面,不吸烟和无脑转移的患者OS更长。

Objective To retrospectively analyze the efficacy and safety of chemotherapy combined with bevacizumab and immunotherapy in patients with advanced non-small cell lung cancer(NSCLC)with epidermal growth factor receptor(EG-FR)exon 20insertion mutation and to analyze the influencing factors affecting their long-term survival,so as to provide a basis for clinical guidance.Methods A total of 60patients with advanced NSCLC with EGFR 20exon insertion mutation who attended 42cases in Shandong Cancer Hospital,13cases in Linyi Cancer Hospital and 5cases in Feixian People’s Hospital from January 1,2016to December 31,2020were retrospectively analyzed,including 27males and 33females,45patients younger than 65years old and 15patients 65years old and above.To compare treatment outcomes,including objective remission rate(ORR),disease control rate(DCR),progression-free survival time(PFS),overall survival(OS),and incidence of adverse drug reactions,in patients receiving chemotherapy combined with immunotherapy(immune group,n=29)and combined with bevacizumab(bevac group,n=31).Results PFS was 9.7 months in 60patients,and the PFS(13.0months vs 8.3months,P=0.044)and ORR(69.0%vs 41.9%,P=0.035)were higher in the immune group than in the bevac group.In patients with brain metastases,PFS was better in the bevac group(13.4months)than in the immune group(10.5months),P=0.047;in patients with smoking,PFS was better in the immune group (10.0months)than in the bevac group(7.2months),P=0.044.Adverse drug reactions were mostly gastrointestinal reactions and bone marrow suppression,with no statistically significant differences between the two groups(both P>0.05),while the incidence of fever was higher in the immune group than in the bevac group,P=0.049.OS was 21.7months in 60patients,smoking(P=0.013)and brain metastasis(P=0.023)were independent risk factors for OS.Conclusions Patients with EGFR 20exon insertional mutation NSCLC have significantly better ORR and PFS in the immune group than in the bevac group,but the incidence of fever is increased.Patients with brain metastases have better treatment effects in the bevac group;smoking patients have better treatment effects in the immune group.In terms of survival,OS is longer in patients who do not smoke and have no brain metastases.