Clinical outcomes of gefitinib and erlotinib in patients with NSCLC harboring uncommon EGFR mutations: a pooled analysis of 438 patients
A partir d'une revue de la littérature et de données portant sur un total de 438 patients atteints d'un cancer du poumon non à petites cellules présentant des mutations inhabituelles du gène EGFR, cette étude compare l'efficacité, du point de vue du taux de réponse objective, de la survie sans progression et de la survie globale, du géfitinib et de l'erlotinib
Background : The purpose of this study was to investigate the outcomes of gefitinib and erlotinibin patients with non-small cell lung cancer (NSCLC) with uncommon epidermal growthfactor receptor (EGFR) mutations. Methods : Relevant researches were identified by a literature search of the PubMed database.Patients with EGFR mutations other than exon 19 deletion and L858R were eligible forthe study. Clinical outcomes included objective response rate (ORR), progression freesurvival (PFS), and overall survival (OS). We categorized all uncommon EGFR mutationsas: single uncommon EGFR mutations and compound mutations that containing 2 or morekinds of EGFR mutations. We also assessed outcomes in patients categorized by EGFR-TKIs:(1) gefitinib group; (2) erlotinib group. Results : A total of 438 patients with NSCLC harboring uncommon EGFR mutations were includedin this study. The ORR for gefitinib and erlotinib was 43.8%, with a median PFS (mPFS)of 6.00 months and a median OS (mOS) of 20.50 months. Patients with compound mutationshad an ORR of 56.3% and an mPFS of 8.10 months. Both of them were significantly betterthan these in patients with single uncommon EGFR mutation, which were 29.3% and 3.90months, respectively (odds ratio (ORa): 2.74, 95% confidence interval (CI): 1.86-4.05, P < 0.001; hazard ratio (HR): 0.58, 95% CI: 0.48-0.71, P < 0.001). Moreover, patients with compound mutations containing 19 deletion or L858Rhad a superior response and survival benefits compared to patients with other compoundmutation patterns. In addition, the gefitinib group showed a favorable efficacy advantage(P = 0.003) and PFS benefit (P = 0.021) compared to the erlotinib group. Conclusions : Uncommon EGFR mutations exhibit favorable but inconsistent treatment responses and survival outcomes to gefitinib and erlotinib, which are closely related to the mutation pattern, the cooccurring partner mutant genes, and the type of EGFR-TKIs received.
Lung Cancer 2022