Equal Efficacy of Gefitinib in Chemonaïve Lung Adenocarcinoma Patients with either Exon 19 Deletion or L858R Mutation

Gefitinib 對於未接受化學治療的 Exon 19 deletion 及 L858R 二種基因變異之肺腺癌病患有相同療效

林倬漢(Chou-Han Lin) ； 王秉槐(Ping-Huai Wang) ； 郭耀文(Yao-Wen Kuo) ； 何肇基(Chao-Chi Ho)

《胸腔醫學》 32卷1期 (2017/02) Pp. 14-23

摘要

Introduction: Whether there exists a differential or equal efficacy of tyrosine kinase inhibitors (TKIs) based on the epidermal growth factor receptor (EGFR) is still debated. We undertook a study to evaluate the clinical efficacy of gefitinib as first-line treatment in patients with lung adenocarcinoma carrying an exon 19 deletion or L858R point mutation. Methods: We retrospectively reviewed lung adenocarcinoma patients who received gefitinib for advanced disease. Their charts and images were reviewed. Results: In all, 151 patients met the criteria for inclusion in the study. The exon 19 deletion was found in 67/151 (44%) patients and the L858R point mutation in 84/151 (56%). The median progression-free survival (PFS) in the overall patient population was 15.6 months. The median PFS was 15.3 months for patients with an exon 19 deletion and 17.7 months for those with an L858R point mutation (p=0.69). The median PFS of patients with postoperative recurrence was 20.1 months, and for those with stage IIIB/IV, 12.7 months (p=0.014). In patients with stage IIIB/IV disease, the median PFS was 14.6 months for those with an exon 19 deletion and 12.6 months for those with an L858R point mutation (p=0.48). Multivariate analysis revealed that postoperative recurrence was an independent prognostic factor for better PFS (hazard ratio, 0.43; p=0.016). Conclusions: There was no difference in the clinical efficacy of gefitinib in lung adenocarcinoma patients harboring either an exon 19 deletion or an L858R point mutation. Patients with postoperative recurrence of disease had a favorable prognosis and should be separated from patients with stage IIIB/IV in future clinical trials.

關鍵字

gefitinib ； epidermal growth factor receptor ； lung cancer

並列摘要

背景：酪胺酸激酶抑制劑對於deletion 19 及L858R 二組病患，在臨床療效是否有差異，研究以gefitinib 作為第一線藥物治療的病人。方法：以gefitinib 做第一線藥物的肺腺癌病人，回顧其病歷和影像。結果：151 位病患中，67 位（44%）是deletion 19，84（56%）是L858R，全部病患的無惡化存活期中位數為15.6 個月，deletion 19 的病患是15.3 個月，L858R 的病患是17.7 個月（p=0.69）。術後復發的病人為20.1 個月，第三期B/ 第四期的病患為12.7 個月（p=0.014）。在第三期B/ 第四期的病患中，deletion19 的病患為14.6 個月，L858R 的病患為12.6 個月（p=0.48）。多變數分析發現，術後復發為一獨立的預後因子（風險比值：0.43; p=0.016）。結論：Gefitinib 對於deletion 19 及L858R 變異的肺腺癌病患，二者無臨床療效差異，而術後復發的病患和第三期B/ 第四期病患，其預後不同，在往後研究中，應將二者分開。

並列關鍵字

酪胺酸激酶抑制劑 ； 表皮生長因子受體 ； 肺癌