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Background <p>The C797S mutation is a prevalent resistance mechanism to third-generation EGFR tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). Management of C797S-positive NSCLC encompasses diverse approaches, including targeted and chemotherapy-based therapies.</p> Methods <p>This analysis included 44 C797S mutant NSCLC patients, all of whom had developed resistance to third-generation EGFR TKIs and had comprehensive treatment and survival data available.</p> Results <p>In the collective C797S + NSCLC cohort, chemotherapy-based therapies demonstrated superior progression-free survival (PFS) relative to non-chemotherapy treatments (5.5 versus 3.4 months, <i>p</i> = 0.014). Specific median PFS outcomes for various regimens were as follows: chemotherapy plus bevacizumab, 6.4 months; chemotherapy with both immunotherapy and bevacizumab, 6.1 months; and chemotherapy with immunotherapy, 4.2 months; chemotherapy alone, 3.8 months. Monotherapy and combinations involving anlotinib, different generations of EGFR TKIs, brigatinib with cetuximab, and immunotherapy alone ranged from 3.5 to 1.5 months. Among T790M+/C797S + cis patients, those receiving chemotherapy-based regimens experienced longer PFS compared to those treated with brigatinib and cetuximab (6.0 versus 2.9 months, <i>p</i> = 0.018). The T790M-/C797S + subgroup saw greater PFS benefits from EGFR TKI-based therapies compared to chemotherapy-based therapies (5.8 versus 4.8 months, <i>p</i> = 0.043).</p> Conclusions <p>To date, chemotherapy-based treatments remain the standard of care for C797S + NSCLC patients resistant to third-generation EGFR TKIs. However, for T790M-/C797S + patients received a third-generation EGFR TKI as first-line therapy, EGFR-TKI rechallenge, involving a combination of first and third-generation EGFR TKIs or first/second-generation TKIs, may be an optimal strategy.</p>

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Real-world analysis of subsequent-line strategies for EGFR C797S mutant non-small cell lung cancer patients acquired resistance to third-generation EGFR tyrosine kinase inhibitors

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月22日

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  • Jianlin Xu,
  • Anshun Zhu,
  • Yingqi Xu,
  • Yidan Zhang,
  • Yinchen Shen,
  • Yongliang Niu,
  • Hua Zhong,
  • Runbo Zhong

摘要

Background

The C797S mutation is a prevalent resistance mechanism to third-generation EGFR tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). Management of C797S-positive NSCLC encompasses diverse approaches, including targeted and chemotherapy-based therapies.

Methods

This analysis included 44 C797S mutant NSCLC patients, all of whom had developed resistance to third-generation EGFR TKIs and had comprehensive treatment and survival data available.

Results

In the collective C797S + NSCLC cohort, chemotherapy-based therapies demonstrated superior progression-free survival (PFS) relative to non-chemotherapy treatments (5.5 versus 3.4 months, p = 0.014). Specific median PFS outcomes for various regimens were as follows: chemotherapy plus bevacizumab, 6.4 months; chemotherapy with both immunotherapy and bevacizumab, 6.1 months; and chemotherapy with immunotherapy, 4.2 months; chemotherapy alone, 3.8 months. Monotherapy and combinations involving anlotinib, different generations of EGFR TKIs, brigatinib with cetuximab, and immunotherapy alone ranged from 3.5 to 1.5 months. Among T790M+/C797S + cis patients, those receiving chemotherapy-based regimens experienced longer PFS compared to those treated with brigatinib and cetuximab (6.0 versus 2.9 months, p = 0.018). The T790M-/C797S + subgroup saw greater PFS benefits from EGFR TKI-based therapies compared to chemotherapy-based therapies (5.8 versus 4.8 months, p = 0.043).

Conclusions

To date, chemotherapy-based treatments remain the standard of care for C797S + NSCLC patients resistant to third-generation EGFR TKIs. However, for T790M-/C797S + patients received a third-generation EGFR TKI as first-line therapy, EGFR-TKI rechallenge, involving a combination of first and third-generation EGFR TKIs or first/second-generation TKIs, may be an optimal strategy.