PMID- 37197626
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230519
IS  - 2218-6751 (Print)
IS  - 2226-4477 (Electronic)
IS  - 2218-6751 (Linking)
VI  - 12
IP  - 4
DP  - 2023 Apr 28
TI  - Immunotherapy for non-small cell lung cancer with EGFR or HER2 exon 20 insertion 
      mutations: a real-world analysis.
PG  - 797-807
LID - 10.21037/tlcr-23-167 [doi]
AB  - BACKGROUND: Due to less sensitivity to classic tyrosine kinase inhibitors, 
      effective first-line treatment is limited in non-small cell lung cancer (NSCLC) 
      patients with epidermal growth factor receptor (EGFR) or human epidermal growth 
      factor receptor 2 (HER2) exon 20 insertion (ex20ins) mutations. Meanwhile, the 
      impact of driver genes on the efficacy of PD-1 inhibitors is discrepant. Our 
      study aimed to assess the clinical response to immunotherapy in NSCLC patients 
      with EGFR or HER2 ex20ins mutations. In parallel, patients treated with 
      chemotherapy but without immunotherapy were included as controls. METHODS: We 
      retrospectively reviewed patients harboring ex20ins mutations treated with immune 
      checkpoint inhibitors (ICIs) and/or chemotherapy in the real world. The clinical 
      response was assessed by progression-free survival (PFS) and the objective 
      response rate (ORR). Propensity score matching (PSM) was performed to control for 
      confounding factors between immunotherapy and chemotherapy. RESULTS: Of 72 
      patients enrolled, 38 had been treated with one line of single-agent 
      immunotherapy or combined therapy including immunotherapy, and 34 had received 
      conventional chemotherapy without immunotherapy. Among patients treated with 
      immunotherapy, the median PFS was 10.7 months [95% confidence interval (CI): 
      8.2-13.2 months] in the first-line setting, with an ORR of 50% (8/16). The median 
      PFS was significantly longer in the first-line immunotherapy group than in the 
      chemotherapy group (10.7 vs. 4.6 months, P<0.001). A trend of an increased ORR in 
      patients who received ICIs was observed compared with chemotherapy, but there was 
      no statistical difference (50% vs. 21.9%, P=0.096). After PSM, the median PFS 
      with first-line immunotherapy was still longer than that with chemotherapy (10.7 
      vs. 4.6 months, P=0.028). Grade 3-4 adverse events (AEs) were observed in 13.2% 
      (5/38) of patients, with the majority developing granulocytopenia (40%, 2/5). One 
      patient discontinued treatment due to a grade 3 rash after three cycles of ICI 
      plus anlotinib treatment. CONCLUSIONS: The results showed that immunotherapy 
      combined with chemotherapy may play a role in the first-line treatment of NSCLC 
      patients with ex20ins mutations. This finding requires further investigation for 
      application.
CI  - 2023 Translational Lung Cancer Research. All rights reserved.
FAU - Zhang, Mai
AU  - Zhang M
AD  - Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan 
      University, Chengdu, China.
AD  - Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
AD  - Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China 
      Hospital, Sichuan University, Chengdu, China.
AD  - Department of Radiation Oncology, The First Affiliated Hospital, Air Force 
      Medical University, Xi'an, China.
FAU - Huang, Qian
AU  - Huang Q
AD  - Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan 
      University, Chengdu, China.
AD  - Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
FAU - Yu, Min
AU  - Yu M
AD  - Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China 
      Hospital, Sichuan University, Chengdu, China.
FAU - Xue, Jianxin
AU  - Xue J
AD  - Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China 
      Hospital, Sichuan University, Chengdu, China.
FAU - Huang, Meijuan
AU  - Huang M
AD  - Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China 
      Hospital, Sichuan University, Chengdu, China.
FAU - Lu, You
AU  - Lu Y
AD  - Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China 
      Hospital, Sichuan University, Chengdu, China.
FAU - Zhang, Yan
AU  - Zhang Y
AD  - Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan 
      University, Chengdu, China.
AD  - Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
LA  - eng
PT  - Journal Article
DEP - 20230426
PL  - China
TA  - Transl Lung Cancer Res
JT  - Translational lung cancer research
JID - 101646875
PMC - PMC10183400
OTO - NOTNLM
OT  - EGFR exon 20 insertion
OT  - HER2 exon 20 insertion
OT  - Non-small cell lung cancer (NSCLC)
OT  - first-line treatments
OT  - immunotherapy
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://tlcr.amegroups.com/article/view/10.21037/tlcr-23-167/coif). The authors 
      have no conflicts of interest to declare.
EDAT- 2023/05/18 01:07
MHDA- 2023/05/18 01:08
PMCR- 2023/04/28
CRDT- 2023/05/17 20:04
PHST- 2023/02/06 00:00 [received]
PHST- 2023/04/19 00:00 [accepted]
PHST- 2023/05/18 01:08 [medline]
PHST- 2023/05/18 01:07 [pubmed]
PHST- 2023/05/17 20:04 [entrez]
PHST- 2023/04/28 00:00 [pmc-release]
AID - tlcr-12-04-797 [pii]
AID - 10.21037/tlcr-23-167 [doi]
PST - ppublish
SO  - Transl Lung Cancer Res. 2023 Apr 28;12(4):797-807. doi: 10.21037/tlcr-23-167. 
      Epub 2023 Apr 26.