1. Pemetrexed-based chemotherapy for non-small-cell lung cancer patients with EGFR exon 20 insertion mutation: a multicenter study
- Author
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Ke-Lin She, Meiyu Fang, Lei Lei, Jinluan Li, You-cai Zhu, Wu Zhuang, Zongyang Yu, Wen-Bin Gao, Yong Fang, Dong Wang, Xiaohui Chen, Liping Wang, Yinbin Zhang, Wenxian Wang, Yue-Fen Zhou, Zhao-Lei Cui, Liyun Miao, Shi-jie Lan, Chuang-Zhou Rao, Qiming Wang, Yong Song, Hong Wang, Xingxiang Pu, Jian-Hui Huang, Tangfeng Lv, Xin Cai, and Chunwei Xu
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,non-small cell lung cancer (NSCLC) ,EGFR Exon 20 Insertion Mutation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Epidermal growth factor receptor ,education ,Lung cancer ,education.field_of_study ,Chemotherapy ,biology ,business.industry ,medicine.disease ,030104 developmental biology ,Pemetrexed ,030220 oncology & carcinogenesis ,biology.protein ,business ,medicine.drug ,Cohort study - Abstract
Background Chemotherapy is the major choice for advanced non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor exon 20 insertion (EGFR ex20ins). The efficacy of pemetrexed-based with other chemotherapy regimens and EGFR ex20ins subtypes in this population has not been well studied. Methods We screened patients with EGFR ex20ins by next-generation sequencing (NGS) from a large cohort. The clinicopathologic and medical information were collected in advanced NSCLC patients with EGFR ex20ins. We also compared the clinical outcomes among patients with different subtypes of EGFR ex20ins. Results We retrospectively collected 119 stage IIIB/IV NSCLC patients with EGFR ex20ins from 9142 NSCLC patients across China from June 2013 to December 2018. The subtypes of EGFR ex20ins included A767_V769dupASV (33/119, 27.73%), S768_D770dupSVD (19/119, 15.97%), N771_H773dupNPH (11/119, 9.24%), A763_Y764insFQEA (2/119, 1.68%) and others (54/119, 45.38%). A total of 64.7% (77/119) of patients received pemetrexed-based first-line chemotherapy and 13.45% (16/119) of patients received pemetrexed-based second-line chemotherapy. Pemetrexed-based chemo-treated patients had longer median progression-free survival (PFS) than patients without pemetrexed-based chemo-treated (5.5 vs. 3.0 months, P=0.0026). Survival data was available for 66 patients and the median overall survival (OS) was 24.7 months. Pemetrexed-based chemo-treated patients had longer OS tendency than patients without pemetrexed-based chemo-treated (25.0 vs. 19.6 months, P=0.0769). Patients harboring A767_V769dupASV had better OS than other subtypes of EGFR ex20ins but without statistical significance (P=0.0676). Multivariate analysis revealed that histological type of NSCLC and bone-metastasis before treatment were independent prognostic factors for OS in all patients after adjusting all characteristic and treatment factors (P Conclusions To the best of our knowledge, it is the largest cohort study of advanced NSCLC patients with EGFR ex20ins across China. Pemetrexed-based treatment could have better control of disease than non-pemetrexed-based chemotherapies in this population. Furthermore, more effective agents are expected for patients harboring EGFR ex20ins.
- Published
- 2020