Abstract:
Objective To analyze the response of epidermal growth factor receptor (
EGFR) non-exons-18-21-mutated advanced non-small cell lung cancer (NSCLC) to targeted therapy, immunotherapy, and chemotherapy.
Methods This study collected the clinical data of 35 patients with
EGFR non-exons-18-21 pure mutation and 65 patients with
EGFR non-exons-18-21 compound mutation in the next generation sequencing (NGS) database of Guangdong Lung Cancer Institute (GLCI) from 2016 to 2020, and collected the clinical data of 567 patients with
EGFR exons-18-21 mutation in GLCI from 2016 to 2019. Clinicopathological characteristics of the three groups were compared, and the response of patients with
EGFR non-exons-18-21 mutations to different treatments were analyzed.
Results The clinicopathological characteristics of the
EGFR non-exons-18-21 compound mutation group were consistent with those of the
EGFR exons-18-21 mutation group, but showed significant differences in gender (
P<0.001), smoking history (
P<0.001), and pathological type (
P<0.001) compared with those of the
EGFR non-exons-18-21 pure mutation group. In the
EGFR non-exons-18-21 compound mutation group, the progression-free survival (PFS) of patients receiving first- or second-generation EGFR-tyrosine kinase inhibitors (TKIs) (
n=26) was 9.4 months, which was no significant difference from that of patients with
EGFR exons-18-21 mutation with or without propensity score matching (PSM) (before PSM:
P=0.76; after PSM:
P=0.76). And the PFS of patients receiving third-generation EGFR-TKIs (
n=23) was 9.5 months, which was also no significant difference from that of patients with
EGFR exons-18-21 mutation with or without PSM (before PSM:
P=0.23; after PSM:
P=0.19). In
EGFR non-exons-18-21 pure mutation group, the PFS of patients receiving immunotherapy and chemotherapy were 4.2 months and 5.4 months, respectively.
Conclusions After NGS detected
EGFR non-exons-18-21 mutation, patients with
EGFR non-exons-18-21 compound mutations could also benefit from first- to third-generation EGFR-TKIs. And the response of immunotherapy and chemotherapy in patients with
EGFR non-exons-18-21 pure mutations were similar to that of
EGFR wild-type NSCLC. In the future, we need to explore the efficacy of EGFR-TKIs in
EGFR non-exons-18-21 pure mutated NSCLC.