Epidermal growth factor receptor (EGFR) deletion of exon 19 and exon 21 mutations are the most common mutations in advanced non-small cell lung cancer (NSCLC) and predict higher sensitivity to EGFR tyrosine kinase inhibitors (TKI). The present study is a retrospective analysis of patients harboring EGFR exon 19 deletions and exon 21 mutations in advanced NSCLC.
Data of patients diagnosed with advanced NSCLC patients with EGFR mutations from January 2012 to March 2019 was analysed. EGFR mutation analysis was performed using DNA sequencing by real time polymerase chain reaction method. Exon 19 and exon 21 mutated patients were compared for clinicopathological features and outcomes.
Data of 697 patients with lung cancer was retrieved of which 613 patients had advanced NSCLC. A total of 441 patients were evaluated for EGFR mutations and 135 (30.6%) patients were positive for EGFR mutations. The median age at presentation was 57.5 years(range, 30-88). Smoking history was seen in 38 (28.1%) patients and 97 (71.8%) were non smokers. Of these 135 patients with EGFR positivity, 129(95.6%) had adenocarcinoma histology and 6(4.4%) had adenosquamous histology. Exon 19 and exon 21 mutations accounted for 79(58.5%) and 45(33.33%) cases respectively. Mutations in exon 18, exon 20 and double mutations were seen in 2(1.4%), 3(2.2%) and 6(4.4%) patients respectively. Thirty nine (28.8%) patients received initial chemotherapy followed by switch maintenance. Geftinib (82.2%) was the most common TKI used followed by erlotinib (9.6%), Afatinib (4.5%), Osimeritinib (0.8%) and chemotherapy (2.9%). The clinical profile, treatment details and outcomes are tabulated below. The median PFS and OS were 8.9 months (range, 4-42 months) and 18 months (range,4-46 months) respectively. Table: 493POverall EGFR Positive(n = 135) Exon 19 deletions(n = 79) Exon 21 Mutated (n = 45) P Value Median Age (years) 57.5 (range, 30-88) 55 (range, 35-88) 61 (range, 30-80) Sex: Male Female Ratio 75 60 1.25:1 44 35 1.25:1 25 20 1.25:1 0.98 Smoker: Yes No 38 97 26 53 11 34 0.32 Metastases: Bone B/L lung Pleural effusion Brain Liver 67 58 40 22 10 39 32 22 20 8 26 22 13 2 1 0.36 0.38 0.9 0.03 0.24 Rash Grade 1 Grade 2 Grade 3 37 20 10 7 23 8 10 5 13 11 0 2 0.8 Response evaluated Partial response Stable disease Progressive disease 111 48 (43.3%) 49 (44.1%) 14 (12.6%) 65 27 (41.6%) 31 (47.7%) 7 (10.7%) 38 18 (47.4%) 16 (42.1%) 4 (10.5%) 0.5 0.6 0.7 Median PFS (months) 8.9 9.2 8.3 0.8 Median OS (months) 18 18.9 17 0.5
In patients with EGFR-sensitizing mutations, tyrosine kinase inhibitors offer superior progression free survival and response rates and are well tolerated. Brain metastases at presentation were significantly higher in exon 19 compared to exon 21. No significant differences were observed in median PFS or median OS in EGFR exon 19 deleted or Exon 21 mutated subgroup.
Department of Medical Oncology, Nizam\'s Institute of Medical Sciences.
Has not received any funding.
All authors have declared no conflicts of interest.