Efficacy of first-line treatment with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) alone or in combination with chemotherapy for advanced non-small cell lung cancer (NSCLC) with low-abundance mutation

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 128; pp. 6 - 12
• Main Authors: Yan, Xiangtao, Wang, Huijuan, Li, Peng, Zhang, Guowei, Zhang, Mina, Yang, Jinpo, Zhang, Xiaojuan, Zheng, Xuanxuan, Ma, Zhiyong
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2019
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; EGFR; EGFR-TKI; ErbB Receptors - genetics; Female; First-Line treatment; Humans; Kaplan-Meier Estimate; Low-Abundance mutation; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Male; Middle Aged; Mutation; Mutation Rate; Neoplasm Metastasis; Neoplasm Staging; NSCLC; Prognosis; Proportional Hazards Models; Protein Kinase Inhibitors - administration & dosage; Survival Analysis; Treatment Outcome; EGFR-TKI; NSCLC; Low-Abundance mutation; First-Line treatment; EGFR
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2018.12.007

•Retrospectively identified patients with low-abundance EGFR mutations.•EGFR-TKI combined with chemotherapy is better than TKI alone.•EGFR-TKI combined with chemotherapy was well tolerated. Objective: The objective of this study was to investigate whether first-line treatment with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in combination with chemotherapy improves the prognosis of patients with advanced non-small cell lung cancer (NSCLC) who harbour low-abundance EGFR mutations. Patients and methods: We retrospectively analysed the clinical data of 76 patients with advanced NSCLC who harboured low-abundance EGFR mutations. The patients were divided into the combination group and the monotherapy group. The combination group received EGFR-TKI combined with a platinum-based regimen. After the end of chemotherapy, EGFR-TKI was administered daily. The monotherapy group was administered EGFR-TKI therapy daily. Results: No significant difference was observed in response rate between the different groups. The median PFS and OS were significantly longer in the combination group than in the monotherapy group (PFS: 7.9 months [95% CI,5.73–10.07] vs 5.9 months [95% CI, 4.99–6.81], p = 0.015; OS: 25.8 months[95% CI,16.27–35.33] vs 19.8 months [95% CI, 18.60–21.00], p = 0.047). Subgroup analysis showed that, for patients with the exon 21 L858R mutation, the PFS and OS were significantly longer in the combination group than in the monotherapy group (PFS: 7.2 months vs 5.8 months, p = 0.013; OS: 22.0 months vs 18.7 months, p = 0.024). The incidence of adverse events was significantly higher in the combination group. Conclusion: For patients with advanced NSCLC and low-abundance EGFR mutations, first-line treatment with EGFR-TKI plus chemotherapy significantly improved PFS and OS. The combination therapy increased the incidence of adverse reactions, but all adverse reactions were expected and tolerated.