期刊
CLINICAL LUNG CANCER
卷 22, 期 3, 页码 E395-E404出版社
CIG MEDIA GROUP, LP
DOI: 10.1016/j.cllc.2020.06.005
关键词
Chemotherapy; EGFR-TKI therapy; Gradual disease progression; Mutation-negative EGFR-T790M; NSCLC
类别
资金
- Western Medicine Guide Project of the Shanghai Committee of Science and Technology [16411964700, 18411968500]
- AstraZeneca
- DIAN Diagnostics
This study compared the efficacy of simultaneous EGFR-TKI and chemotherapy with sequential treatment in patients with EGFR-T790M mutation negative non-small-cell lung cancer. The results showed that EGFR-TKI combined with chemotherapy conferred longer progression-free survival and overall survival in this patient population.
This study aimed to compare the efficacy and safety of simultaneous EGFR tyrosine kinase inhibitor (TKI) and chemotherapy with that of sequential treatment after disease gradually progressed from first-line EGFR-TKI treatment and EGFR-T790M mutation negativity. Overall survival, progression-free survival, overall response rate, disease control rate, and adverse events were assessed. EGFR-TKI combined with chemotherapy conferred more survival benefits than sequential EGFR-TKI and chemotherapy. Introduction: Continuing tyrosine kinase inhibitor (TKI) therapy may be beneficial when patients with non-small-cell lung cancer and EGFR mutations experience gradual disease progression after initial EGFR-TKI treatment. We aimed to compare the efficacy of simultaneous EGFR-TKI and chemotherapy with that of sequential treatment after patients' disease gradually progressed after first-line EGFR-TKI treatment. Patients and Methods: Patients with gradual progression who were EGFR-T790M mutation negative were randomly divided into two groups. In the concurrent group, patients were treated with pemetrexed plus cisplatin along with the same EGFR-TKI. In the sequential group, patients continued with EGFR-TKI until the disease progressed again, according to RECIST, then switched to chemotherapy. We evaluated the patients' progression-free survival (PFS) and overall survival times. Results: Ninety-nine patients were enrolled: 49 in the concurrent group and 50 in the sequential group. The median PFS (mPFS) was 7.7 months (95% confidence interval [CI], 3.6-11.7) in the concurrent group and 5.7 months (95% CI, 3.5-7.9) in the sequential group (hazard ratio = 0.66; 95% CI, 0.44-1.00; P =.026), respectively. For the sequential group, the mPFS1 and mPFS2 were 1.8 months (95% CI, 1.4-2.3) and 3.8 months (95% CI, 3.1-4.5), respectively. The median overall survival of the concurrent group was longer than that of the sequential group (20.0 vs. 14.7 months; hazard ratio = 0.52; 95% CI, 0.32-0.85; P =.038). Conclusion: For patients with advanced non-small-cell lung cancer and gradual progression who are EGFR-T790M mutation negative after initial EGFR-TKI therapy, EGFR-TKI combined with chemotherapy confers longer PFS and overall survival than sequential EGFR-TKI and chemotherapy does. (C) 2020 Elsevier Inc. All rights reserved.
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