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局部晚期或转移性肺腺癌罕见基因突变患者的临床特征和生存分析
Clinical characteristics and survival analysis of rare mutations in locally advanced or metastatic lung adenocarcinoma
- 陆军军医大学学报 2022年44卷第24期 页码：2474-2485
- 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：
[ 周建英，E-mail: zjyhz@zju.edu.cn ZHOU Jianying, E-mail: zjyhz@zju.edu.cn
- 基金信息：浙江省重点研发项目(2019C03042)
DOI：10.16016/j.2097-0927.202210118
中图分类号： R181.32;R734.2;R969.4收稿：2022-10-14，
修回：2022-11-18，
纸质出版：2022-12-30
- 稿件说明：
移动端阅览
林青岳, 屈晶晶, 周建英. 局部晚期或转移性肺腺癌罕见基因突变患者的临床特征和生存分析[J]. 陆军军医大学学报, 2022,44(24):2474-2485.
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.
林青岳, 屈晶晶, 周建英. 局部晚期或转移性肺腺癌罕见基因突变患者的临床特征和生存分析[J]. 陆军军医大学学报, 2022,44(24):2474-2485. DOI： 10.16016/j.2097-0927.202210118.
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
2
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
E
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
2
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
E
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
2
在
BRAF V
600
E
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
vs
. 6.3
vs
.4.7个月，
P
=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
vs
. 5.2
vs
.2.9个月，
P
=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
vs
. 7.8
vs
. 6.7个月，
P
=0.092 3)。
结论
2
选择性靶向药可能对
BRAF V
600
E
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
2
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
E
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
2
A retrospective cohort study was performed on 14 patients with
BRAF V
600
E
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
2
In the first-line treatment of the patients with
BRAF V
600
E
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
vs
6.3 and 4.7 months
P
=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
vs
5.2 and 2.9 months
P
=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
vs
7.8 and 6.7 months
P
=0.092 3).
Conclusion
2
Targeted therapeutic drugs may be more effective in advanced lung adenocarcinoma patients with
BRAF V
600
E
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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