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Zhang W, Zhang Y, Zhao Q, Liu X, Chen L, Pan H, Li Y, Lu Y, Huang J, Zhang Z, Du K, Zhang S, Li T, Lu L, Yu G, Wang Y, Yuan X, Yang M, Ma Y, Tan F. Long-term safety of icotinib in patients with non-small cell lung cancer: a retrospective, real-world study. J Thorac Dis 2020; 12:639-650. [PMID: 32274129 PMCID: PMC7139014 DOI: 10.21037/jtd.2019.12.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Lung cancer is a global health problem with a high mortality, and the development of target therapy has led to a revolution in the treatment of lung cancer in recent years. Favorable efficacy and safety of icotinib have been demonstrated in patients with non-small cell lung cancer (NSCLC). Currently, minimal data are available to describe the long-term safety of icotinib in NSCLC patients. Methods We reviewed the safety data from 1,321 advanced NSCLC patients who were treated with icotinib. The primary endpoint was the long-term safety, defined as any adverse drug reactions (ADRs) occurred after 6 months of icotinib administration. Results Fewer ADRs were noticed over 6 month administration of icotinib than within 6 months in overall population (24.3% vs. 65.4%), and elderly patients (23.6% vs. 66.9%). The majority of ADRs were grade 1–2 in severity over 6 month exposure of icotinib in overall population as well as elderly patients. In overall population, the most common ADRs of icotinib during long-term use were rash (16.4%) and diarrhea (5.3%), while the incidences were 31.8% and 13.2% in the induction period, respectively. In elderly population, the most common ADRs of icotinib during long-term use were rash (15.7%) and diarrhea (4.7%), while the incidences were 27.8% and 14.9% in the induction period, respectively, and more inching was observed in the induction period as compared with long term use (6.3% vs. 0.3%). Conclusions There was an evidence of decreased frequency of icotinib-induced ADRs over time, and icotinib was well-tolerated in elderly NSCLC patients.
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Affiliation(s)
- Wen Zhang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of People's Liberation Army General Hospital (304 Hospital), Beijing 100048, China
| | - Yiping Zhang
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qiong Zhao
- The Affiliated Shulan Hospital, Medical School of Zhejiang Shuren University, Hangzhou 310000, China
| | - Xiguang Liu
- Department of Oncology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Likun Chen
- Department of Medical Oncology, Sun-Yet San University Cancer Center, Guangzhou 510060, China
| | - Hongming Pan
- Department of Oncology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou 310016, China
| | - Yuping Li
- Department of Respiratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - You Lu
- Thoracic Cancer Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianjin Huang
- Department of Oncology, the Second Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhe Zhang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao 266011, China
| | - Kaiqi Du
- Department of Thoracic Surgery, Chinese People's Armed Police Force, Zhejiang Corps Hospital, Hangzhou 314000, China
| | - Suning Zhang
- Department of Thoracic Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Tao Li
- Radiation Therapy Department, Sichuan Cancer Hospital & Institute, Chengdu 610041, China
| | - Liqin Lu
- Department of Oncology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
| | - Guangmao Yu
- Department of Cardio-Thoracic Surgery, Shaoxing People's Hospital, Shaoxing 312000, China
| | - Yang Wang
- Betta Pharmaceuticals Co., Ltd, Hangzhou 311100, China
| | - Xiaobin Yuan
- Betta Pharmaceuticals Co., Ltd, Hangzhou 311100, China
| | - Min Yang
- Betta Pharmaceuticals Co., Ltd, Hangzhou 311100, China
| | - Yongbin Ma
- Betta Pharmaceuticals Co., Ltd, Hangzhou 311100, China
| | - Fenlai Tan
- Betta Pharmaceuticals Co., Ltd, Hangzhou 311100, China
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Li X, Zhang L, Jiang D, Wang Y, Zang A, Ding C, Zhao M, Su W, Zhang Y, Zhong D, Wu J, Zhang C, An G, Hu X, Cheng G, Wang H, Li Y, He X, Liu J, Liang L, Ding L, Mao L, Zhang S. Routine-Dose and High-Dose Icotinib in Patients with Advanced Non-Small Cell Lung Cancer Harboring EGFR Exon 21-L858R Mutation: the Randomized, Phase II, INCREASE Trial. Clin Cancer Res 2020; 26:3162-3171. [PMID: 32060099 DOI: 10.1158/1078-0432.ccr-19-3064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/12/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Our primary purpose is to explore safety and efficacy of high-dose icotinib in comparison with routine-dose icotinib in patients with non-small cell lung cancer (NSCLC) harboring 21-L858R mutation. PATIENTS AND METHODS Patients with treatment-naïve, EGFR-mutant (21-L858R or exon 19 deletion at 2:1) NSCLC were enrolled. Patients with 21-L858R mutation were randomized to receive routine-dose icotinib (125 mg, thrice daily; L858R-RD) or high-dose icotinib (250 mg, thrice daily; L858R-HD), whereas patients with exon 19 deletion received only routine-dose icotinib (19-Del-RD) until progression, death, or unacceptable toxicity. The primary endpoint was median progression-free survival (mPFS), assessed by an independent review committee. RESULTS From May 2015 to November 2017, 253 patients (86 in L858R-RD; 90 in L858R-HD; and 77 in 19-Del-RD) were enrolled. The mPFS in L858R-HD group was similar to that in 19-Del-RD group (12.9 months and 12.5 months, respectively) and was significantly longer than that in L858R-RD group [12.9 months vs. 9.2 months, hazard ratio (HR): 0.75; 95% confidence interval (CI), 0.53-1.05]. A longer but statistically nonsignificant mPFS was observed between 19-Del-RD and L858R-RD groups (12.5 months vs. 9.2 months, HR: 0.80; 95% CI, 0.57-1.13). A higher objective response rate (ORR) was observed in L858R-HD group compared with L858R-RD group (73% vs. 48%), also between 19-Del-RD and L858R-RD groups (75% vs. 48%). Similar incidences of grade 3/4 toxicities were observed among the three treatment groups. CONCLUSIONS High-dose icotinib improved mPFS and ORR in patients with NSCLC harboring 21-L858R mutation with acceptable tolerability, which could be a new therapeutic option for this patient population.
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Affiliation(s)
- Xi Li
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Li Zhang
- Respiratory Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Da Jiang
- Department of Medical Oncology, The Forth Hospital of Hebei Medical University, Tumor Hospital of Hebei Province, Shijiazhuang, China
| | - Yan Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aimin Zang
- Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Department of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, China
| | - Cuimin Ding
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Min Zhao
- Department of Oncology, Hebei Chest Hospital, Shijiazhuang, Hebei, China
| | - Wuyun Su
- Department of Medical Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yan Zhang
- Department of Oncology, Affiliated People's Hospital of Hebei Medical University, Shijiazhuang, China
| | - Diansheng Zhong
- Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jin Wu
- Department of Head and Neck and Genito-Urinary Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cuiying Zhang
- Department of Medical Oncology, People's Hospital of Inner Mongolia Autonomous Region, Hohhot, China
| | - Guangyu An
- Department of Medical Oncology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xingsheng Hu
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Cheng
- Department of Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Huaqing Wang
- Department of Respiratory Medicine, Tianjin People's Hospital, Tianjin, China
| | - Yongqun Li
- Respiratory Department, Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaohui He
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junli Liu
- Department of Medical Oncology, Xingtai People's Hospital of Hebei Medical University, Xingtai, China
| | - Li Liang
- Department of Oncology, Peking University Third Hospital, Beijing, China
| | | | - Li Mao
- Betta Pharmaceutical Co., Ltd., Hangzhou, China
| | - Shucai Zhang
- Department of Medical Oncology, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China.
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Li HY, Xie Y, Yu TT, Lin YJ, Yin ZY. Durable response to pulsatile icotinib for central nervous system metastases from EGFR-mutated non-small cell lung cancer: A case report. World J Clin Cases 2020; 8:370-376. [PMID: 32047787 PMCID: PMC7000937 DOI: 10.12998/wjcc.v8.i2.370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) metastases are a catastrophic complication of non-small cell lung cancer (NSCLC), including brain and leptomeningeal carcinomatosis, and are always accompanied by a poor prognosis. Despite the continuous development of existing treatments, the therapy of CNS metastases remains challenging.
CASE SUMMARY We report a patient who was definitively diagnosed with brain and leptomeningeal metastases from NSCLC with a targeted mutation in epidermal growth factor receptor (EGFR). A standard dosage of icotinib (125 mg three times daily) was implemented but ineffective. CNS lesions developed despite stable systemic control, so pulsatile icotinib (1125 mg every 3 d) was administered. This new strategy for administration has lasted 25 mo so far, and resulted in complete remission of neurological symptoms, almost vanished lesions, and longer survival with no notable side effects.
CONCLUSION This is the first successful example of pulsatile icotinib for treating isolated CNS progression from EGFR mutation-positive NSCLC, providing a new alternative for the local treatment of CNS metastases.
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Affiliation(s)
- Hui-Ying Li
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yu Xie
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Ting-Ting Yu
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yong-Juan Lin
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Zhen-Yu Yin
- Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Bajaj G, Gupta M, Wang HH, Barrett JS, Tan M, Rupalla K, Bertz R, Sheng J. Challenges and Opportunities With Oncology Drug Development in China. Clin Pharmacol Ther 2018; 105:363-375. [DOI: 10.1002/cpt.1017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 12/31/2022]
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