BACKGROUND Insertions in exon 19 in the epidermal growth factor receptor gene(EGFR)is a rarely seen mutation in non-small cell lung cancer.These patients have been effectively treated with sequential EGFR tyrosine kin...BACKGROUND Insertions in exon 19 in the epidermal growth factor receptor gene(EGFR)is a rarely seen mutation in non-small cell lung cancer.These patients have been effectively treated with sequential EGFR tyrosine kinase inhibitors(TKIs).CASE SUMMARY Here,we presented a case of non-small cell lung cancer,stage IIIB,with EGFR exon 19 insertion mutation as detected in the right lower lobe by next-generation sequencing.The patient was sequentially treated with first,second,and thirdgeneration EGFR TKIs after the surgical operation.The overall survival of the patient was 21.3 mo.There was no dynamic analysis of drug resistance mechanisms in targeted therapy.CONCLUSION This case emphasized the importance of following the guidelines.In patients with EGFR mutations,repeated and dynamic next-generation sequencing monitoring is necessary to prescribe a personalized treatment plan.展开更多
Background:Epidermal growth factor receptor(EGFR) mutations,including a known exon 19 deletion(19 del) and exon 21 L858 R point mutation(L858R mutation),are strong predictors of the response to EGFR tyrosine kinase in...Background:Epidermal growth factor receptor(EGFR) mutations,including a known exon 19 deletion(19 del) and exon 21 L858 R point mutation(L858R mutation),are strong predictors of the response to EGFR tyrosine kinase inhibitor(EGFR-TKI) treatment in lung adenocarcinoma.However,whether patients carrying EGFR 19 del and L858 R mutations exhibit different responsiveness to EGFR-TKls and what are the potential mechanism for this difference remain controversial.This study aimed to investigate the clinical outcomes of EGFR-TKI treatment in patients with EGFR 19 del and L858 R mutations and explore the genetic heterogeneity of tumors with the two mutation subtypes.Methods:Of 1127 patients with advanced lung adenocarcinoma harboring EGFR 19 del or L858 R mutations,532 received EGFR-TKI treatment and were included in this study.EGFR 19 del and L858 R mutations were detected by using denaturing high-performance liquid chromatography(DHPLC).T790 M mutation,which is a common resistant mutation on exon 20 of EGFR,was detected by amplification refractory mutation system(ARMS).Next-generation sequencing(NGS) was used to explore the genetic heterogeneity of tumors with EGFR 19 del and L858 R mutations.Results:Of the 532 patients,319(60.0%) had EGFR 19 del,and 213(40.0%) had L858 R mutations.The patients with EGFR 19 del presented a significantly higher overall response rate(ORR) for EGFR-TKI treatment(55.2%vs.43.7%,P = 0.017) and had a longer progression-free survival(PFS) after first-line EGFR-TKI treatment(14.4 vs.11.4 months,P = 0.034) compared with those with L858 R mutations.However,no statistically significant difference in overall survival(OS) was observed between the two groups of patients.T790 M mutation status was analyzed in 88 patients before EGFR-TKI treatment and 134 after EGFR-TKI treatment,and there was no significant difference in the co-existence of T790 M mutation with EGFR 19 del and L858 R mutations before EGFR-TKI treatment(5.6%vs.8.8%,P = 0.554)or after treatment(24.4%vs.35.4%,P = 0.176).In addition,24 patients with EGFR 19 del and 19 with L858 R mutations were analyzed by NGS,and no significant difference in the presence of multiple somatic mutations was observed between the two genotypes.Conclusions:Patients with EGFR 19 del exhibit longer PFS and higher ORR compared with those with L858 R mutations.Whether the heterogeneity of tumors with EGFR 19 del and L858 R mutations contribute to a therapeutic response difference needs further investigation.展开更多
目的比较一代表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)联合化疗对两种表皮生长因子受体(EGFR)经典突变非小细胞肺癌(NSCLC)的疗效。方法选取2017年4月至2019年12月郑州大学第一附属医院肿瘤科收治的34例EGFR经典突变的晚期NSCLC患...目的比较一代表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)联合化疗对两种表皮生长因子受体(EGFR)经典突变非小细胞肺癌(NSCLC)的疗效。方法选取2017年4月至2019年12月郑州大学第一附属医院肿瘤科收治的34例EGFR经典突变的晚期NSCLC患者。患者均接受一代EGFR-TKIs联合化疗治疗。按基因突变种类将患者分为两组,即EGFR基因19外显子缺失突变(19Del突变)为A组(18例),EGFR基因21外显子L858R点突变(21L858R突变)为B组(16例)。研究的主要终点为中位无进展生存时间(PFS)和1 a PFS率,次要终点为客观缓解率(ORR)。比较两组不良反应。结果治疗后,B组ORR[25.0%(4/16)]较A组[88.9%(16/18)]低(P<0.05)。B组1 a PFS率[25.0%(4/16)]与A组[44.4%(8/18)]比较,差异无统计学意义(P>0.05)。B组中位PFS短于A组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论接受一代EGFR-TKIs联合化疗治疗的EGFR基因19Del突变的NSCLC患者较EGFR基因21L858R突变患者的PFS更长。展开更多
文摘BACKGROUND Insertions in exon 19 in the epidermal growth factor receptor gene(EGFR)is a rarely seen mutation in non-small cell lung cancer.These patients have been effectively treated with sequential EGFR tyrosine kinase inhibitors(TKIs).CASE SUMMARY Here,we presented a case of non-small cell lung cancer,stage IIIB,with EGFR exon 19 insertion mutation as detected in the right lower lobe by next-generation sequencing.The patient was sequentially treated with first,second,and thirdgeneration EGFR TKIs after the surgical operation.The overall survival of the patient was 21.3 mo.There was no dynamic analysis of drug resistance mechanisms in targeted therapy.CONCLUSION This case emphasized the importance of following the guidelines.In patients with EGFR mutations,repeated and dynamic next-generation sequencing monitoring is necessary to prescribe a personalized treatment plan.
基金supported by grants from the National Natural Sciences Foundation Key Program(No.81330062)Education Ministry Innovative Research Team Program(No.IRT13003)+1 种基金Peking University-Tsinghua University Joint Center for Life Sciences Clinical Investigator,National High Technology Research and Development Program 863(No.SS2015AA020403)Beijing Technology Project(No.Z141100000214013)
文摘Background:Epidermal growth factor receptor(EGFR) mutations,including a known exon 19 deletion(19 del) and exon 21 L858 R point mutation(L858R mutation),are strong predictors of the response to EGFR tyrosine kinase inhibitor(EGFR-TKI) treatment in lung adenocarcinoma.However,whether patients carrying EGFR 19 del and L858 R mutations exhibit different responsiveness to EGFR-TKls and what are the potential mechanism for this difference remain controversial.This study aimed to investigate the clinical outcomes of EGFR-TKI treatment in patients with EGFR 19 del and L858 R mutations and explore the genetic heterogeneity of tumors with the two mutation subtypes.Methods:Of 1127 patients with advanced lung adenocarcinoma harboring EGFR 19 del or L858 R mutations,532 received EGFR-TKI treatment and were included in this study.EGFR 19 del and L858 R mutations were detected by using denaturing high-performance liquid chromatography(DHPLC).T790 M mutation,which is a common resistant mutation on exon 20 of EGFR,was detected by amplification refractory mutation system(ARMS).Next-generation sequencing(NGS) was used to explore the genetic heterogeneity of tumors with EGFR 19 del and L858 R mutations.Results:Of the 532 patients,319(60.0%) had EGFR 19 del,and 213(40.0%) had L858 R mutations.The patients with EGFR 19 del presented a significantly higher overall response rate(ORR) for EGFR-TKI treatment(55.2%vs.43.7%,P = 0.017) and had a longer progression-free survival(PFS) after first-line EGFR-TKI treatment(14.4 vs.11.4 months,P = 0.034) compared with those with L858 R mutations.However,no statistically significant difference in overall survival(OS) was observed between the two groups of patients.T790 M mutation status was analyzed in 88 patients before EGFR-TKI treatment and 134 after EGFR-TKI treatment,and there was no significant difference in the co-existence of T790 M mutation with EGFR 19 del and L858 R mutations before EGFR-TKI treatment(5.6%vs.8.8%,P = 0.554)or after treatment(24.4%vs.35.4%,P = 0.176).In addition,24 patients with EGFR 19 del and 19 with L858 R mutations were analyzed by NGS,and no significant difference in the presence of multiple somatic mutations was observed between the two genotypes.Conclusions:Patients with EGFR 19 del exhibit longer PFS and higher ORR compared with those with L858 R mutations.Whether the heterogeneity of tumors with EGFR 19 del and L858 R mutations contribute to a therapeutic response difference needs further investigation.
文摘目的比较一代表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)联合化疗对两种表皮生长因子受体(EGFR)经典突变非小细胞肺癌(NSCLC)的疗效。方法选取2017年4月至2019年12月郑州大学第一附属医院肿瘤科收治的34例EGFR经典突变的晚期NSCLC患者。患者均接受一代EGFR-TKIs联合化疗治疗。按基因突变种类将患者分为两组,即EGFR基因19外显子缺失突变(19Del突变)为A组(18例),EGFR基因21外显子L858R点突变(21L858R突变)为B组(16例)。研究的主要终点为中位无进展生存时间(PFS)和1 a PFS率,次要终点为客观缓解率(ORR)。比较两组不良反应。结果治疗后,B组ORR[25.0%(4/16)]较A组[88.9%(16/18)]低(P<0.05)。B组1 a PFS率[25.0%(4/16)]与A组[44.4%(8/18)]比较,差异无统计学意义(P>0.05)。B组中位PFS短于A组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论接受一代EGFR-TKIs联合化疗治疗的EGFR基因19Del突变的NSCLC患者较EGFR基因21L858R突变患者的PFS更长。
