Clinical characteristics and survival analysis of rare mutations in locally advanced or metastatic lung adenocarcinoma

Qingyue LIN; Jingjing QU; Jianying ZHOU

doi:10.16016/j.2097-0927.202210118

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Clinical characteristics and survival analysis of rare mutations in locally advanced or metastatic lung adenocarcinoma

Monographic Reports: Targeted therapy of lung cancer | 更新时间：2026-01-09

- Clinical characteristics and survival analysis of rare mutations in locally advanced or metastatic lung adenocarcinoma
- Journal of Army Medical University Vol. 44, Issue 24, Pages: 2474-2485(2022)
- 作者机构：
  
  310003 杭州，浙江大学医学院附属第一医院呼吸与危重症医学科
- 作者简介：
- 基金信息：
  
  the Key Research and Development Program of Zhejiang Province(2019C03042)
- DOI：10.16016/j.2097-0927.202210118
  CLC： R181.32;R734.2;R969.4
- Received：14 October 2022，
  
  Revised：2022-11-18，
  
  Published：30 December 2022
- 稿件说明：
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Qingyue LIN, Jingjing QU, Jianying ZHOU. Clinical characteristics and survival analysis of rare mutations in locally advanced or metastatic lung adenocarcinoma[J]. Journal of Army Medical University, 2022, 44(24): 2474-2485.
DOI：

Qingyue LIN, Jingjing QU, Jianying ZHOU. Clinical characteristics and survival analysis of rare mutations in locally advanced or metastatic lung adenocarcinoma[J]. Journal of Army Medical University, 2022, 44(24): 2474-2485. DOI： 10.16016/j.2097-0927.202210118.

摘要

目的

观察鼠类肉瘤病毒癌基因同源物B1(v-raf murine sarcoma viral oncogene homolog B1，

BRAF

)

BRAF V

600

突变、人表皮生长因子受体2(human epidermal growth factor receptor 2，

HER

2)突变、转染重排(rearranged during transfection，

RET

)融合基因、表皮生长因子受体(epidermal growth factor receptor，

EGFR

) 20外显子插入(

EGFR

exon 20 insertion mutations，

EGFR

20-

ins

)突变的晚期肺腺癌患者接受不同治疗方案的疗效和安全性，为指导临床提供依据。

方法

采用回顾性队列研究设计方案，将2019年10月至2021年12月就诊于浙江大学附属第一医院的14例

BRAF V

600

突变患者、22例

HER

2突变患者、20例

RET

融合基因患者及15例

EGFR

20-

ins

突变患者纳入本研究。将不同突变组患者分别分为化疗±贝伐珠单抗组、化疗+免疫检查点抑制剂(immune checkpoint inhibitors，ICIs)组及选择性靶向药组，比较各突变组内不同治疗方案的疗效和药物不良反应。

结果

在

BRAF V

600

突变患者的一线治疗中，达拉非尼-曲美替尼组的中位无进展生存期(median progression-free survival，mPFS)优于化疗±贝伐珠单抗组及化疗+ICIs组，但差异无统计学意义(15.8

. 6.3

.4.7个月，

=0.426 5)；在

HER

2阳性患者的一线治疗中，化疗+ICIs组的mPFS优于化疗±贝伐珠单抗组及

HER

2抑制剂组，差异有统计学意义(8.7

. 5.2

.2.9个月，

=0.013 5)；在

RET

融合基因患者的一线治疗中，

RET

抑制剂组的mPFS优于化疗±贝伐珠单抗组及化疗+ICIs组，差异无统计学意义(17.5

. 7.8

. 6.7个月，

=0.092 3)。

结论

选择性靶向药可能对

BRAF V

600

突变、

RET

融合基因晚期肺腺癌患者一线治疗更有效，而化疗联合免疫治疗可能对

HER

2阳性晚期肺腺癌患者一线治疗更有效。

Abstract

Objective

To analyze the efficacy and safety of different treatments in advanced lung adenocarcinoma patients with v-raf murine sarcoma viral oncogene homolog B1(

BRAF

)

BRAF V

600

mutation

human epidermal growth factor receptor 2 (

HER

2) mutation

rearranged during transfection (

RET

) fusion gene and

EGFR

exon 20 insertion (

EGFR

20-

ins

)mutations in order to provide references for clinical guidance.

Methods

A retrospective cohort study was performed on 14 patients with

BRAF V

600

mutation

22 patients with

HER

2 mutation

20 patients with

RET

fusion gene and 15 patients with

EGFR

20-

ins

mutation who were admitted to our hospital between October 2019 and December 2021. The patients from different mutation groups were divided into chemotherapy±bevacizumab subgroup

chemotherapy+immune checkpoint inhibitors(ICIs) subgroup

and selective targeted drug subgroup. The efficacy and adverse events were compared in each mutation group.

Results

In the first-line treatment of the patients with

BRAF V

600

mutation

the median progression-free survival (mPFS) was longer in the dabrafenib-trametinib subgroup than the chemotherapy±bevacizumab subgroup and chemotherapy+ICIs subgroup (15.8

6.3 and 4.7 months

=0.426 5)

but there were significant differences. In the first-line treatment of

HER

2-positive patients

the mPFS in the chemotherapy+immune subgroup was statistically better than the chemotherapy±bevacizumab subgroup and the

HER

2 inhibitor subgroup (8.7

5.2 and 2.9 months

=0.013 5). In the first-line treatment of the patients with

RET

fusion gene

the mPFS

in the

RET

inhibitor subgroup was longer than that of the chemotherapy±bevacizumab subgroup and that of the chemotherapy+ICIs subgroup

without statistical significances (17.5

7.8 and 6.7 months

=0.092 3).

Conclusion

Targeted therapeutic drugs may be more effective in advanced lung adenocarcinoma patients with

BRAF V

600

mutation and

RET

fusion gene than those at first-line

while chemotherapy combined with immunotherapy may be more effective in the patients with

HER

2-positive at first line.

关键词

Keywords

references

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