Primary versus acquired epidermal growth factor receptor Thr790Met mutant non‑small cell lung cancer: clinical features and prognoses

• Mengying Li ^[1] ; Xiaohan Wang ^[1] ; Siqi Zhou ^[1] ; Guoxin Cai ^[2] ; Ying Fu ^[2] ; Xue Meng ^[2] ; Xiao Han ^[2] ; Kaiyue Wang ^[2]
  1. [1] Department of Oncology, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
  2. [2] Department of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital and Institute, Jiyan Road 440, Jinan 250117, Shandong, China
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 26, Nº. 6, 2024, págs. 1395-1406
• Idioma: inglés
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• Resumen

  • Purpose This study aimed to identify the impact of epidermal growth factor receptor (EGFR) T790M mutations on clinical characteristics and prognosis.

    Methods Retrospective analyses were conducted on the differences on clinicopathological features and prognosis between primary and acquired T790M mutations. Subgroup analyses were performed for primary T790M coexisting with other mutations.

    Results Patients with primary T790M mutations showed a 60.53% (23/38) incidence of concurrent L858R mutations, 18.42% (7/38) for 19del mutations and a 21.05% (8/38) occurrence of brain metastases. Conversely, those with acquired T790M mutations demonstrated respective frequencies of 36.53% (61/167), 58.68% (98/167) and 44.31% (74/167), with all comparisons yielding p<0.05. The median overall survival difered signifcantly between the two groups, with a duration of 33 months for patients with primary T790M mutations as compared to 48 months for those with acquired mutations (p=0.030). Notably, among patients with L858R co-mutations, when treated with third-generation EGFR-TKIs, those with acquired T790M mutations experienced a signifcantly prolonged median time to treatment failure compared to those with primary mutations (17 months vs. 9 months, p=0.009).

    Conclusion Patients with primary T790M have unique molecular features and had worse prognosis compared with acquired T790M. Resistance to third-generation EGFR-TKIs seems to be associated with the presence of EGFR co-mutations.