Progress of Immunotherapy in EGFR-mutated Advanced Non-small Cell Lung Cancer / 中国肺癌杂志

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are currently the first-line standard of care for patients with non-small cell lung cancer (NSCLC) that harbor EGFR mutations. Nevertheless, resistance to EGFR-TKIs is inevitable. In recent years, although immune checkpoint inhibitors (ICIs) have significantly shifted the treatment paradigm in advanced NSCLC without driver mutation, clinical benefits of these agents are limited in patients with EGFR-mutated NSCLC. Compared with wild-type tumors, tumors with EGFR mutations show more heterogeneity in the expression level of programmed cell death ligand 1 (PD-L1), tumor mutational burden (TMB), and other tumor microenvironment (TME) characteristics. Whether ICIs are suitable for NSCLC patients with EGFR mutations is still worth exploring. In this review, we summarized the clinical data with regard to the efficacy of ICIs in patients with EGFR-mutated NSCLC and deciphered the unique TME in EGFR-mutated NSCLC.
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EGFR gene mutations and environmental exposure factors in patients with non-small cell lung cancer in Bazhong City / 公共卫生与预防医学

Objective To analyze the EGFR gene mutations and environmental exposure factors in patients with non-small cell lung cancer (NSCLC) in Bazhong City, and to provide a theoretical basis for the diagnosis and treatment of NSCLC patients. Methods A total of 356 NSCLC patients admitted to Bazhong Hospital from 2019 to 2020 were selected. All patients underwent EGFR gene detection and were divided into mutant group (n=171) and wild-type group (n=185) according to EGFR gene mutation. Environmental exposure data of patients were collected, including smoking status, smoking index, frequent frying of food, etc. Univariate analysis and logistic regression were used to analyze the environmental risk factors of EGFR gene mutations in NSCLC patients. Results A total of 171 EGFR gene mutations were detected in 356 NSCLC patients, and the mutation rate was 48.03%. The mutation rate of EGFR gene in females was significantly higher than that in males (P0.05). The mutation rate of EGFR gene in patients with adenocarcinoma was significantly higher than that in patients without adenocarcinoma (P0.05). Among the 356 NSCLC patients, there were 171 cases with EGFR gene mutations (48.03%), including 335 single mutations, 181 exon 19 mutations, 129 exon 21 L858R mutations, 12 exon 21 L861Q mutations, 8 exon 20 insertion mutations, and 5 Exon 18 mutations. There were 18 cases carrying double mutations and 3 cases carrying triple mutations. There were significant differences between the two groups in smoking status, smoking index, use of coal stove, use of smoke extraction equipment, cooking fumes, fried food intake, and family history of cancer (P<0.05). Non-smoking (OR=3.19), not using smoke exhaust equipment (OR=3.58), and using coal stove (OR=2.19) were the environmental exposure factors of EGFR mutation in NSCLC patients (P<0.05). Conclusion The EGFR gene mutation rate is high in NSCLC patients in Bazhong City, and most of them are female non-smoking patients. EGFR gene detection should be performed in NSCLS patients without smoke exhaust equipment and using coal stoves to improve the detection rate of EGFR mutation.

Analysis of clinicopathological features of seven patients with lung adenocarcinoma translating to small cell lung cancer / 中国肿瘤临床

Objective: To analyze the clinicopathological features of small cell lung cancer transformed from lung adenocarcinoma. Methods: We retrospectively analyzed the clinical and pathological characteristics and follow-up data of seven patients who had been diagnosed with small cell lung cancer transformed from lung adenocarcinoma following treatment from January 2014 to December 2018 at the Fourth Hospital of Hebei Medical University. Results: The latest follow-up had been performed on June 1, 2020. The median time of small cell lung cancer transformation from lung adenocarcinoma following treatment was 31 months; the median time of tyrosine kinase inhibitor (TKI) application before transformation is 14 months. Three patients had transformation at the same site as the original. Seven patients had higher levels of neuron-specific enolase (NSE) before transformation. Before the transformation, disease progression mostly occurred at multiple sites, and the lung, bone, brain, pleura, and lymph nodes were commonly affected. In all cases, immunohistochemical indicators after transformation showed that thyriod transcription factor-1 (TTF-1) was positive; Napsin A was negative; Syn, CD56, and AE1/AE3 were positive; Ki67 expression was high; and PD-L1 expression was negative. Genetic testing after transformation showed that six patients had maintained the original mutant EGFR gene. Treatments after transformation were mainly comprehensive, based on chemotherapy. The median progression-free survival time after transformation was 6 months, and median survival time after transformation for five patients who died was 10 months. Conclusions: Once lung adenocarcinoma undergoes transformation to small cell lung cancer, the disease progresses rapidly, and survival time is short. Patients with lung adenocarcinoma due to EGFR E19 mutation who undergo EGFR-TKI therapy are more prone to small cell lung cancer transformation, and the time to transformation generally exceeds 2 years. The sites of disease progression before transformation are often multiple, and NSE is increased. After transformation, patients generally maintain the original EGFR mutation.

Clinical applicability of xTAG liquidchip technology as EGFR mutations detection method in lung cancer / 临床与实验病理学杂志

Purpose To analyze EGFR exon 18 ~21 gene mutations in lung cancer, and compare xTAG liquidchip technology and Sanger sequencing technology in clinical practice. Methods 1 139 tumor tissue samples from phaseⅠtoⅣlung cancer patients were randomly collected. DNA was extracted from the samples. EGFR gene mutation status in exon 18~21 was detected by xTAG liquidchip technology and Sanger sequencing technology respectively. Results The mutation status of EGFR was obtained by xTAG liquidchip technology in 1 134 patients, and 1 105 by Sanger sequencing technology, detection success rate was 99. 56% and 97. 01% respective-ly. The sensitivity and specificity of xTAG liquidchip technology Comparing with Sanger sequencing was 99. 59% and 94. 54%. Sever-al cases of multiple mutations were detected by both methods. All mutation types detected by two methods are fully consistent. Conclu-sions Comparing with Sanger sequencing technology, xTAG liquidchip technology, which is able to detect mutations of exon 18~21 simultaneously, is more convenient and efficient for EGFR gene mutation detection in lung cancer.