Abstract
AimsIn this study, we determined whether different subtypes of epidermal growth factor receptor (EGFR) exon19 mutation are associated with the therapeutic effect of EGFR-tyrosine kinase inhibitors (TKIs) on advanced non-small cell lung adenocarcinoma.MethodsA total of 122 patients with stage III or IV non-small cell lung adenocarcinoma were retrospectively reviewed. Clinical characteristics of these patients, including progression-free survival (PFS) outcome for EGFR-TKI treatment, were analyzed.ResultsAccording to the mutation pattern, we classified the in-frame deletions detected on EGFR Exon19 into three different types: codon deletion (CD), with a deletion of one or more original codons; codon substitution and skipping (CSS), with a deletion of one or two nucleotides but the residues could be translated into a new amino acid without changing following amino acid sequence; CD or CSS plus single nucleotide variant (SNV) (CD/CSS+SNV), exclude CD or CSS, there’s another SNV nearby the deletion region. The clinical characteristics of three groups were analyzed and as a result, no significant difference was found. By comparing the average number of missing bases and amino acids of the three mutation subtypes, it could be discovered that the number of missing bases and amino acids of the three mutation subtypes is diverse, and group CSS> group CD> group CD/CSS+SNV. Finally, survival analysis was performed between three groups of patients. The median PFS of group CD, group CSS and group CD/CSS+SNV was 11 months, 9 months and 14 months respectively. There was a distinct difference in the PFS between group CSS and group CD/CSS+SNV (P = 0.035<0.05), and the PFS of group CD/CSS+SNV was longer.ConclusionsDifferent mutation subtypes of EGFR exon19 can predict the therapeutic effect of EGFR-TKIs on advanced non-small cell lung adenocarcinoma.
Highlights
Lung cancer is the leading cause of cancer-related death worldwide[1]
According to the mutation pattern, we classified the in-frame deletions detected on epidermal growth factor receptor (EGFR) Exon19 into three different types: codon deletion (CD), with a deletion of one or more original codons; codon substitution and skipping (CSS), with a deletion of one or two nucleotides but the residues could be translated into a new amino acid without changing following amino acid sequence; CD or CSS plus single nucleotide variant (SNV) (CD/CSS+SNV), exclude CD or CSS, there’s another SNV nearby the deletion region
Different mutation subtypes of EGFR exon19 can predict the therapeutic effect of EGFRTKIs on advanced non-small cell lung adenocarcinoma
Summary
Lung cancer is the leading cause of cancer-related death worldwide[1]. Non-small cell lung cancer (NSCLC) accounts for about 85% of lung cancer[2, 3]. It is important to screen out these patients who showing a better response to EGFR-TKIs. Epidermal growth factor (EGF) and its receptor (EGFR), which is most closely related to lung adenocarcinoma, were discovered by Stanley Cohen of Vanderbilt university in 1986[7]. Patients with EGFR 19 del results different PFS after EGFR TKI treatment, and the reason is still not clear. This retrospective study reviewed the medical records of EGFR exon mutant advanced NSCLC patients undergoing EGFR-TKIs treatment, so as to evaluate the association of different subtypes of exon mutation with EGFR-TKI efficacy in EGFR-mutant advanced non-small cell lung adenocarcinoma patients
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