Sequential treatment in advanced epidermal growth factor receptor-mutated lung adenocarcinoma patients receiving first-line bevacizumab combined with 1st/2nd-generation EGFR-tyrosine kinase inhibitors

Frontiers in Oncology

Oncology

Chiao-En Wu¹  Chin-Chou Wang²  Yu-Ching Lin³  Chun-Yao Huang⁴  Suey-Haur Lee⁵  Jia-Shiuan Ju⁶  Allen Chung-Cheng Huang⁶  Cheng-Ta Yang⁷  Scott Chih-Hsi Kuo⁸  Ping-Chih Hsu⁸  Li-Chung Chiu⁸  Ho-Wen Ko⁸ 

[1] Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan;Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Division of Thoracic Oncology, Department of Respiratory and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan;Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi County, Taiwan;Department of Pulmonary and Critical Care, Buddhist Tzu Chi General Hospital, New Taipei City, Taiwan;Division of Pulmonary & Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan;Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan;Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan;Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan;Division of Thoracic Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan;Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;

关键词: epidermal growth factor receptor mutation;    tyrosine kinase inhibitor;    bevacizumab;    lung adenocarcinoma;    T790M;    osimertinib;   

DOI  :  10.3389/fonc.2023.1249106

 received in 2023-06-28, accepted in 2023-09-14,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionThe clinical outcomes of sequential treatment of advanced epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) patients with first-line bevacizumab combined with 1st/2nd-generation EGFR-TKIs are unclear. Thus, we aimed to analyze the outcomes of these patients.Methods Between January 2015 and December 2020, data for 102 advanced EGFR-mutated lung adenocarcinoma patients receiving first-line bevacizumab combined with erlotinib or afatinib followed by treatments at multiple institutions were retrospectively analyzed. All patients with progressive disease (PD) after first-line therapy underwent secondary T790M mutation detection.Results The secondary T790M mutation positive rate of all study patients was 57.9%. First-line erlotinib use and progression-free survival (PFS) after first-line therapy > 12 months were positively associated with the T790M mutation (P <0.05). The response rates (RRs) to second-line treatments were 51.7% and 22.7% for the osimertinib and nonosimertinib groups, respectively (P = 0.001). The median PFS associated with second-line osimertinib and nonosimertinib therapy was 13.7 and 7.1 months, respectively (hazard ratio (HR) = 0.38; 95% confidence interval (CI), 0.23–0.63; P< 0.001). Patients with a secondary T790M mutation receiving second-line osimertinib treatment had a median overall survival (OS) of 54.3 months, and the median OS was 31.9 months for non-T790M-mutated patients receiving second-line nonosimertinib treatments (HR = 0.36; CI: 0.21–0.62, P < 0.001).Conclusion The majority of acquired resistance to first-line bevacizumab combined with 1st/2nd-generation EGFR-TKIs is associated with the T790M mutation. Sequential osimertinib treatment in patients with positive secondary T790M mutation is associated with better outcomes among these patients.

【 授权许可】

Unknown   
Copyright © 2023 Hsu, Huang, Lin, Lee, Chiu, Wu, Kuo, Ju, Huang, Ko, Wang and Yang