外显子19缺失和外显子21 L858R突变对晚期EGFR突变型非小细胞肺癌的免疫治疗效果：一项直接和间接meta分析

IF 4 2区医学 Q2 ONCOLOGY

Translational lung cancer research Pub Date : 2025-02-28 Epub Date: 2025-02-12 DOI:10.21037/tlcr-24-884

Zihong Chen, Lanlan Pang, Yuwen Yang, Xinyi He, Jianhua Zhan, Lin Zhang, Kangqiao Xiong, Wenfeng Fang, Li Zhang, Yaxiong Zhang

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引用次数: 0

摘要

背景：免疫疗法（IO）对表皮生长因子受体（EGFR）突变的晚期非小细胞肺癌（NSCLC）的治疗效果不佳。然而，先前的研究表明，外显子19缺失（19 Del）和外显子21 L858R突变（21 L858R）之间的IO效果不同。在本研究中，我们旨在评估EGFR 19 Del和EGFR 21 L858R患者IO疗效的差异。方法：提取按EGFR亚型分层的应答率、疾病控制率（DCR）、无进展生存期（PFS）和总生存期（OS）的IO数据，采用随机效应模型，二分数据采用优势比（ORs），生存数据采用风险比（hr）， 95%置信区间（CI）。分别通过直接法和间接法对19例Del和21例L858R的疗效进行比较。结果：共纳入15项研究，涉及1209例egfr突变的晚期NSCLC患者接受IO治疗(19 Del, n=676；21 L858R, n=533)。根据11项研究的数据进行直接荟萃分析，19例Del患者的PFS较短(HR =1.55；95% ci: 1.21-1.98；P=0.001)和OS (HR =1.36；95% ci: 1.04-1.78；P=0.02)和较差的DCR (OR =0.51；95% ci: 0.29-0.87；P=0.02)显著高于21 L858R组。4项试验的间接荟萃分析显示了相同的结果，19 Del患者的PFS显著缩短(HR =1.50；95% ci: 1.09-2.07；P=0.01)。亚组分析也显示出类似的趋势，无论是单药还是联合用药，21 L858R都比19 Del有更多的临床获益。结论：对于晚期EGFR突变的NSCLC患者，与19 Del相比，21 L858R具有更好的IO疗效。

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Immunotherapy efficacy between exon 19 deletion and exon 21 L858R mutation in advanced EGFR mutant non-small-cell lung cancer: a direct and indirect meta-analysis.

Background: Immunotherapy (IO) exhibits poor therapeutic effect in epidermal growth factor receptor (EGFR) mutant advanced non-small-cell lung cancer (NSCLC). However, previous studies reveal different IO efficacy between exon 19 deletion (19 Del) and exon 21 L858R mutation (21 L858R). In this study, we aimed to evaluate the difference in IO efficacy between patients with EGFR 19 Del and EGFR 21 L858R.

Methods: IO data of response rate, disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) stratiﬁed by EGFR subtypes were extracted and synthesized on random-effect model using odds ratios (ORs) for dichotomous data and hazard ratios (HRs) for survival data with 95% confidence interval (CI). Efficacy comparisons between 19 Del and 21 L858R were estimated through direct and indirect methods respectively.

Results: A total of 15 studies that involved 1,209 EGFR-mutant advanced NSCLC patients with IO treatment were included (19 Del, n=676; 21 L858R, n=533). Based on the data from 11 studies for direct meta-analysis, patients with 19 Del had shorter PFS (HR =1.55; 95% CI: 1.21-1.98; P=0.001) and OS (HR =1.36; 95% CI: 1.04-1.78; P=0.02) and poorer DCR (OR =0.51; 95% CI: 0.29-0.87; P=0.02) than those with 21 L858R significantly. Indirect meta-analysis from four trials showed the same result that patients with 19 Del had significantly shorter PFS (HR =1.50; 95% CI: 1.09-2.07; P=0.01) than those with 21 L858R. Subgroup analyses also showed similar tendency that 21 L858R had more clinical benefit compared to 19 Del no matter whether IO monotherapy or IO combination.

Conclusions: For advanced EGFR mutant NSCLC patients, 21 L858R had superior IO efficacy compared with 19 Del.

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来源期刊

Translational lung cancer research Medicine-Oncology

CiteScore

7.20

自引率

2.50%

发文量

137

期刊介绍： Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.