Background: Targeted therapy for patients with driver genes positive and immunotherapy for patients with driver gene-negative but high programmed death ligand 1 (PD-L1) expression are the standards of first-line treatment for patients with advanced non-small cell lung cancer (NSCLC). The treatment options for patients with driver gene positive and high PD-L1 expression are still worth exploring.
Methods: The characteristics of 315 patients with NSCLC were identified to analyze the clinicopathological characteristics of patients with driver gene positive and high PD-L1 expression, and the efficacy of targeted therapy.
Results: Among the 315 patients, the total positive rate of driver genes was 62.2%, and the high PD-L1 expression rate (≥50.0%) was 11.2%. The proportion of patients with driver gene positive and high PD-L1 expression was 10.7%. PD-L1 was highly expressed in patients with epidermal growth factor receptor (EGFR) mutation, KRAS mutation, ALK fusion, BRAF mutation, and MET 14 exon skip mutation, the proportions were 7.8% (11/141), 18.2% (4/22), and 23.1%, (3/13), 50.0% (2/4) and 100.0% (1/1) respectively. EGFR mutation positive with PD-L1 high expression was mainly in patients with stage IV lung adenocarcinoma. KRAS mutation positive with PD-L1 high expression was mainly in patients with a history of smoking. Among them, two patients were followed in detail for targeted therapy, who with ALK fusion-positive and PD-L1 high expression (90.0%), EGFR L858R mutation and PD-L1 high expression (70.0%) respectively. The total OS of the patients was 5 months, 2 months.
Conclusions: The high PD-L1 expression rate in NSCLC patients with different driver gene mutations was variable, which maybe correlated with distinct clinicopathological characteristics. Patients with sensitive mutations and high PD-L1 expression may be less benefit from targeted therapy and have poor prognosis.
【中文题目:驱动基因阳性且PD-L1高表达的非小细胞肺癌患者病理特征及靶向治疗疗效评估 的真实世界研究】 【中文摘要:背景与目的 驱动基因突变阳性患者行靶向治疗,驱动基因阴性但程序性死亡配体1(programmed death-ligand 1, PD-L1)高表达患者行免疫抑制剂治疗,是晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者一线治疗的首选,但对于驱动基因阳性且PD-L1高表达患者的治疗选择仍值得探究。方法 以315例NSCLC患者为研究对象,分析驱动基因阳性且PD-L1高表达患者的临床病理特征及靶向治疗疗效。结果 本研究纳入的315例NSCLC患者中,驱动基因突变总阳性率为62.2%,PD-L1高表达率(≥50.0%)为11.2%,驱动基因阳性且PD-L1高表达的患者比例为10.7%。其中表皮生长因子受体(epidermal growth factor receptor, EGFR)突变、KRAS 突变、ALK融合、BRAF突变和MET 14外显子跳跃突变患者中均有PD-L1高表达,比例分别为7.8%(11/141)、18.2%(4/22)、23.1%(3/13)、50.0%(2/4)和100.0%(1/1)。EGFR突变且PD-L1高表达患者主要为IV期肺腺癌患者,KRAS突变且PD-L1高表达患者主要为有吸烟史的患者。其中详细跟踪了两例分别为ALK融合阳性且PD-L1高表达(90.0%)和EGFR L858R突变且PD-L1高表达(70.0%)患者的靶向治疗全过程,两例患者总生存期分别仅为5个月和2个月。结论 NSCLC患者各驱动基因突变与PD-L1高表达共存的比例和临床病理特征有较大差异。发生敏感突变且PD-L1高表达的患者靶向治疗疗效和预后可能更差。】 【中文关键词:肺肿瘤;驱动基因;程序性死亡配体1;靶向治疗】.
Keywords: Driver mutation; Lung neoplasms; Programmed death-ligand 1; Targeted treatment.