Key prognostic factors for EGFR-mutated non-adenocarcinoma lung cancer patients in the Japanese Joint Committee of Lung Cancer Registry Database

Keigo Kobayashi, Kenzo Soejima, Koichi Fukunaga, Yasushi Shintani, Ikuo Sekine, Takehito Shukuya, Koichi Takayama, Akira Inoue, Isamu Okamoto, Katsuyuki Kiura, Kazuhisa Takahashi, Nobuyuki Yamamoto, Yuichi Takiguchi, Etsuo Miyaoka, Meinoshin Okumura, Ichiro Yoshino

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) for EGFR-mutated non-adenocarcinoma (ADC) non-small cell lung cancer patients is not well established. Herein, we investigated key prognostic factors influencing the efficacy of EGFR-TKIs in these patients. Methods: A total of 12,320 lung cancer patients pathologically diagnosed in 2012 at teaching hospitals in Japan were retrospectively selected. The follow-up survey was closed in 2016. Results: EGFR-mutated non-ADC patients were more prone to malignant pleural effusion (MPE) and distant metastasis than ADC patients (P = 0.071 and 0.022, respectively). EGFR-mutated ADC patients were likely to have a longer median overall survival (OS) than non-ADC patients [hazard ratio (HR) 1.3 (95 % CI, 0.97–1.8, P = 0.072)—29.5 months (95 % CI, 27.9–31.1 months) versus 19.5 months (95 % CI, 10.8–28.2 months) (P = 0.068)]. There was no significant difference in median OS between EGFR-positive ADC and non-ADC patients receiving treatment with first-generation EGFR-TKI. Among EGFR-positive non-ADC patients, the median OS was significantly longer for patients receiving EGFR-TKI treatment than for those who did not [HR 4.5 (95 % CI, 2.1–9.8, P < 0.001)—25.5 months (95 % CI, 8.1–42.9 months) versus 7.5 months (95 % CI, 3.4–11.6 months) (P < 0.001)]. While there was no significant difference in the median OS for ADC patients with either 19 del or L858R mutations, the median OS was significantly longer for EGFR-mutated non-ADC patients with 19 del than for those with L858R mutation (HR 3.2 [95 % CI, 1.5–6.9, P = 0.004]; it was not reached for 19 del and was 15.5 months for L858R [95 % CI, 6.6–24.4 months], P = 0.002). Discussion: EGFR-mutated non-ADC patients were more prone to MPE and distant metastasis. Both ADC and EGFR del19-positive non-ADC patients can benefit from EGFR-TKI treatment, whereas EGFR L858R-positive non-ADC patients might require different therapeutic options.

Original languageEnglish
Pages (from-to)236-243
Number of pages8
JournalLung Cancer
Volume146
DOIs
Publication statusPublished - 2020 Aug

Keywords

  • EGFR mutation
  • EGFR-TKI
  • Lung cancer registry
  • Non-adenocarcinoma
  • Prognostic factor

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

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