Real-world analysis of the effect of gefitinib as a first-line therapy in patients with advanced non-small cell lung cancer with EGFR mutations

  • Pham Van Luan 108 Military Central Hospital
  • Nguyen Dinh Tien 108 Military Central Hospital
  • Nguyen Minh Hai 108 Military Central Hospital
  • Nguyen Dao Tien 108 Military Central Hospital
  • Thi Thi Duyen 108 Military Central Hospital

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Keywords

Non-small cell lung cancer, gefitinib, first-line treatment, EGFR mutations

Tóm tắt

Objective: To evaluate the effect of gefitinib as a first-line therapy in patients with advanced non-small cell lung cancer (NSCLC) who were positive for epidermal growth factor receptor (EGFR) mutations. Subject and method: This prospective analysis included 120 patients with advanced NSCLC with EGFR mutations who were administered gefitinib as the first-line therapy. Patient follow-up and evaluation were performed every three months or when there were symptoms of progressive disease. The main criteria for the analysis of response were progression-free survival (PFS) and overall response rate (ORR). The secondary criteria were overall survival (OS) and disease control rate (DCR). Additionally, the relationship of OS with sex, smoking history, and performance status (PS), as well as gefitinib toxicity were analyzed. Result: The ORR and DCR were 59.2% and 95.8%, respectively. The median PFS was 14.5 months and the median OS was 33 months. The longer OS was statistically significant in women and non-smokers, and the patients had a good PS. Adverse events occurred in 59.2% patients, but most of them were grade 1 and 2 events. Conclusion: This study conducted in Vietnam suggests the effectiveness of gefitinib as a first-line treatment option in patients with advanced NSCLC and positive EGFR mutations regardless of whether the patients have a good PS or not. In particular, targeted therapy with gefitinib improved the OS in women and non-smokers.

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Các tài liệu tham khảo

1. Zhang YL, Yuan JQ, Wang KF et al (2016) The prevalence of EGFR mutation in patients with non-small cell lung cancer: A systematic review and meta-analysis. Oncotarget 7: 78985-78993.
2. Mok TS, Wu YL, Thongprasert S et al (2009) Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Eng J Med 361: 947-958.
3. Maemondo M, Inoue A, Kobayashi K et al (2010) Gefitinib or chemotherapy for non-small cell lung cancer with mutated EGFR. N Engl J Med 362: 2380-2388.
4. Soria JC, Ohe Y, Vansteenkiste J et al (2018) Osimertinib in untreated EGFR-mutated advanced non-small cell lung cancer. N Engl J Med 378: 113-125.
5. Zhou C, Wu YL, Chen G et al (2015) Final overall survival results from a randomised, phase III study of erlotinib versus chemotherapy as first-line treatment of EGFR mutation-positive advanced non-small cell lung cancer (OPTIMAL, CTONG-0802). Ann Oncol 26: 1877-1883.
6. Sequist LV, Yang JC, Yamamoto N et al (2013) Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations, LUX-LUNG 3. J Clin Oncol 31: 3327-3334.
7. Lau SC, Batra U, Mok TS et al (2019) Dacomitinib in the management of advanced non-small cell lung cancer. Drugs 79: 823-831.
8. NCCN Guideline Insights, Non-Small Cell Lung Cancer, version 3.2020, feature updates to the NCCN Guidelines.
9. Shi Y, Au JS, Thongprasert S et al (2014) A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non-small cell lung cancer of adenocarcinoma histology (PIONEER). J Thorac Oncol 9: 154-162.
10. Inoue A, Yoshida K, Morita S et al (2016) Characteristics and overall survival of EGFR-mutation-positive non-small cell lung cancer treated with EGFR tyrosine kinase inhibitors: A retrospective analysis for 1660 Japanese patients. Jpn J Clin Oncol 46: 462-467.
11. Ohe Y, Imamura F, Nogami N et al (2019) Osimertinib versus standard-of-care EGFR-TKI as first-line treatment for EGFRm advanced NSCLC: FLAURA Japanese subset. Jpn J Clin Oncol 49: 29-36.
12. Douillard JY, Ostoros G, Cobo M et al (2014) First-line gefitinib in Caucasian EGFR mutation-positive NSCLC patients: a phage-IV, open-label, single-arm study. Br J Cancer 110: 55-62.
13. Yao ZH, Liao WY, Ho CC et al (2017) Real-world data on prognostic factors for overall survival in EGFR mutation-positive advanced non-small cell lung cancer patients treated with first-line Gefitinib. Oncologist 22: 1075-1083.