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在EGFR阳性晚期非小细胞肺癌中,T790M突变测试和序列性奥西默蒂尼布的现实结果:一项重新审视的策略

Kelvin Yan^1,2, Arizah Bakhtiah³, Shweta Hota³

¹Department of Clinical Oncology, The Chinese University of Hong Kong, Ngan Shing Street, Shatin, Hong Kong. kelvinyan@cuhk.edu.hk.

Targeted oncology

|September 2, 2025

概括

在第一代或第二代EGFR- 铁酶抑制剂 (F- S- EGFR- TKI) 后,对T790M突变的晚期非小细胞肺癌 (eLC) 患者进行序列性 osimertinib (S- OSI) 改善了整体存活率 (OS). 这种策略提供了一个有利的选择,特别是在资源有限的环境中.

科学领域:

癌症学
药理学
遗传学

背景情况:

由表皮生长因子受体 (EGFR) 驱动的非小细胞肺癌 (eLC) 是癌症死亡的重要原因.
与较旧的EGFR- 铁酶抑制剂 (EGFR- TKI) 相比,U- OSI在先进的eLC中显示出更高的整体存活率 (OS).
在第一代或第二代EGFR-TKI (F-S-EGFR-TKI) 之后的顺序性 osimertinib (S-OSI) 在理论上对T790M阳性患者有利.

研究的目的:

确定EGFR突变非小细胞肺癌 (eLC) 患者的最佳测序策略.
为了比较前期 osimertinib (U-OSI) 和顺序性 osimertinib (S-OSI) 的总生存 (OS) 结果.

主要方法:

一项多中心的回顾性研究分析了在2016年至2020年期间接受FS-EGFR-TKI的未经治疗的eLC患者.
评估了T790M测试和S-OSI的符合性和生存结果.
使用卡普兰-梅尔和考克斯比例危险模型进行生存分析.

主要成果:

只有50%的患者在FS-EGFR-TKI测试后接受T790M测试.
在T790M测试患者 (54. 0个月) 和未测试患者 (8. 9个月) 中,中位数的生存率显著更高.
在T790M阳性患者中,S-OSI的平均寿命为64. 0个月,而在T790M阴性患者中为34. 9个月.

结论:

在F-S-EGFR-TKI之后的顺序性 osimertinib (S-OSI) 在现实环境中显示出改善的整体存活率 (OS),无论T790M状态如何.
高性能状态和没有基线内疾病是有利的预后因素.
对于先进的eLC来说,S-OSI是一个临床上有益且具有潜在的成本效益的策略,特别是在资源有限的环境中.

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