The Correlation Between T790M Gene Mutation Of Non-small Cell Lung Cancer And Efficacy Of EGFR-TKI

Background and objective: Currently,the resistance of non-small cell lung cancer(NSCLC)to epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)and subsequent therapy strategy have become research hotspots.The leading mechanism is missense mutation at position 790 in EGFR exon 20(T790M).Recently,with the deepening research of T790 M,increasing studies have been conducted to investigate the correlation between T790 M mutation and the efficacy of EGFR-TKI.However,owing to the variety of outcomes among studies,no definite correlation has been drawn.Thereby,this meta-analysis was conducted to further explore the association between T790 M mutation and the efficacy of EGFR-TKI.Methods: 5128 potentially relevant articles were identified by thoroughly searching Pubmed,Embase,The Cochrane Library,CNKI and Wanfang database.Subsequently,eligible studies were identified according to the inclusion criteria.Moreover,hazard ratio(HR)and 95% confidence intervals(CIs)of progression free survival(PFS)and overall survival(OS)were extracted.Eventually,this meta-analysis was performed via Stata 12.0.Results: 14 eligible studies incorporating 896 cases,consisting of 421 cases with T790 M mutation and 475 cases with T790 M non-mutation,were included.This meta-analysis showed that no significant difference was found between T790 M mutation group and non-mutation group in PFS(HR=1.48,95%CI[0.92,2.39],P=0.106)and OS(HR=1.11,95%CI[0.69,1.79],P=0.662).Furthermore,subgroup analysis revealed that,comparing with T790 M non-mutation group,patients harboring T790 M mutation before administering TKI sufferred a significantly shorter PFS(HR=2.28,95%CI[1.38,3.77],P=0.001)and OS(HR=1.54,95%CI[1.01,2.35],P=0.044).Moreover,in subgroup analysis on patients resisting to prophase TKI,comparing with T790 M non-mutation group,T790 M mutation group possessed a significant shorter PFS when delivering the first generation TKI(HR=2.12,95%CI[1.19,3.79],P=0.011),but an equivalent PFS(HR=0.92,95%CI[0.30,2.86],P=0.884)when administering the second or third generation TKI.Remarkably,no publication bias was found by funnel plot,begg's test and egger's test in our included studies.Conclusions: Comparing with NSCLC without T790 M mutation,patients harboring T790 M mutation obtained less benefit from the first generation TKI.The second or third generation TKI is a potentially effective option for these patients.