A phase III randomised controlled trial of erlotinib vs gefitinib in advanced non-small cell lung cancer with EGFR mutations

Background: A phase III trial was conducted to compare the safety and efficacy of erlotinib with that of gefitinib in advanced non-small cell lung cancer harbouring epidermal growth factor receptor mutations in exon 19 or 21. Methods: Eligible patients were randomised to receive erlotinib (150mg per day) or gefitinib (250mg per day) orally until disease progression or unacceptable toxicity. We aimed to determine whether erlotinib is superior to gefitinib in efficacy. The primary end point was progression-free survival. Results: A total of 256 patients were randomised to receive erlotinib (N = 128) or gefitinib (N = 128). Median progression-free survival was not better with erlotinib than with gefitinib (13.0 vs 10.4 months, 95% confidence interval (CI) 0.62-1.05, P = 0.108). The corresponding response rates and median overall survival were 56.3% vs 52.3% (P = 0.530) and 22.9 vs 20.1 months (95% CI 0.63-1.13, P = 0.250), respectively. There were no significant differences in grade 3/4 toxicities between the two arms (P = 0.172). Conclusions: The primary end point was not met. Erlotinib was not significantly superior to gefitinib in terms of efficacy in advanced non-small cell lung cancer with epidermal growth factor receptor mutations in exon 19 or 21, and the two treatments had similar toxicities.