Erlotinib versus gemcitabine/cisplatin in Chinese patients with EGFR mutation-positive advanced non-small-cell lung cancer: Crossover extension and post-hoc analysis of the ENSURE study
Autor: | Yunzhong Zhu, Ying Cheng, Xiaoqing Liu, Cheng Huang, E. Li, Houjie Liang, Yi-Long Wu, Shukui Qin, Gang Wu, Guo-Liang Jiang, Zhaoyang Zhong, Baohui Han, Caicun Zhou, Shun Lu, Lei Chen, Hongming Pan |
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Rok vydání: | 2018 |
Předmět: |
0301 basic medicine
Oncology Male Cancer Research Lung Neoplasms medicine.medical_treatment Deoxycytidine 0302 clinical medicine Carcinoma Non-Small-Cell Lung Antineoplastic Combined Chemotherapy Protocols Medicine Epidermal growth factor receptor education.field_of_study Cross-Over Studies biology Middle Aged ErbB Receptors Treatment Outcome 030220 oncology & carcinogenesis Female Erlotinib medicine.drug Pulmonary and Respiratory Medicine Adult medicine.medical_specialty China Population 03 medical and health sciences Erlotinib Hydrochloride Internal medicine Humans Lung cancer education Survival analysis Aged Neoplasm Staging Chemotherapy business.industry medicine.disease Survival Analysis Gemcitabine respiratory tract diseases 030104 developmental biology Mutation biology.protein Cisplatin business Progressive disease Follow-Up Studies |
Zdroj: | Lung cancer (Amsterdam, Netherlands). 130 |
ISSN: | 1872-8332 |
Popis: | Objectives Sequential combination of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) and chemotherapy has shown greater benefits than either treatment alone in non-small-cell lung cancer (NSCLC). In this follow-up of the ENSURE study, we evaluated progression-free survival (PFS) with first-line erlotinib followed by chemotherapy at progression versus the inverse treatment sequence in 175 Chinese patients with EGFR mutation-positive NSCLC. Materials and methods Forty-five of the 175 patients included in the follow-up analysis experienced progressive disease (PD). Those with PD on first-line erlotinib (n = 24) received gemcitabine/cisplatin while those who failed first-line chemotherapy (n = 21) received erlotinib until second-line PD. The primary endpoint was PFS in the crossover subpopulation. Post-hoc analysis of survival outcomes was also measured for the overall population of 175 Chinese patients. Results Among patients who crossed over at progression, PFS was comparable between those who received second-line erlotinib and those who received second-line chemotherapy (median, 26.3 months and 23.4 months, respectively; P = 0.529). Regardless of the sequence in which the therapies were administered, patients in the crossover treatment subgroup benefited from either second-line therapy after progression with a median overall survival of 51.6 months versus 23.0 months achieved among patients in the non-crossover treatment subgroup. Post-hoc biomarker analyses of Kaplan–Meier survival curves and Cox regression showed that survival benefits with either treatment sequence were similar between patients with circulating free DNA EGFR mutations in exons 19 and 21; however, those with undetectable mutations achieved significantly greater survival benefits. Conclusion In advanced EGFR mutation-positive NSCLC, first-line erlotinib followed by chemotherapy at progression demonstrated comparable PFS benefit with the inverse treatment sequence, irrespective of mutation subtype. Utilizing both EGFR-TKIs and chemotherapy, irrespective of the sequence, maximizes survival benefits for patients. |
Databáze: | OpenAIRE |
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