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La Salvia A, Rossi A, Galetta D, Gobbini E, De Luca E, Novello S, Di Maio M. Intercalated Chemotherapy and Epidermal Growth Factor Receptor Inhibitors for Patients With Advanced Non-Small-cell Lung Cancer: A Systematic Review and Meta-analysis. Clin Lung Cancer 2016; 18:23-33.e1. [PMID: 27876230 DOI: 10.1016/j.cllc.2016.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/05/2016] [Accepted: 08/23/2016] [Indexed: 11/29/2022]
Abstract
Randomized clinical trials (RCTs) of concurrent epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) plus chemotherapy for unselected patients with advanced non-small-cell lung cancer (NSCLC) produced negative results. Intercalated administration could avoid the reduction of chemotherapy activity due to G1 cell-cycle arrest from EGFR-TKIs. A PubMed search was performed in December 2015 and updated in February 2016. The references from the selected studies were also checked to identify additional eligible trials. Furthermore, the proceedings of the main international meetings were searched from 2010 onward. We included RCTs comparing chemotherapy intercalated with an EGFR-TKI versus chemotherapy alone for patients with advanced NSCLC. Ten RCTs were eligible (6 with erlotinib, 4 with gefitinib): 39% of patients had a known EGFR mutational status, 43% of whom EGFR mutation positive. The intercalated combination was associated with a significant improvement in overall survival (OS; hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.71-0.95; P = .01), progression-free survival (PFS; HR, 0.60; 95% CI, 0.53-0.68; P < .00001), and objective response rate (ORR; odds ratio [OR], 2.70; 95% CI, 2.08-3.49; P < .00001). Considering only first-line trials, similar differences were found in OS (HR, 0.85; 95% CI, 0.72-1.00; P = .05), PFS (HR, 0.63; 95% CI, 0.55-0.73; P < .00001), and ORR (OR, 2.21; 95% CI, 1.65-2.95; P < .00001). In EGFR mutation-positive patients, the addition of an intercalated EGFR-TKI produced a significant benefit in PFS (129 patients; HR, 0.24; 95% CI, 0.16-0.37; P < .00001) and ORR (168 patients; OR, 11.59; 95% CI, 5.54-24.25; P < .00001). In patients with advanced NSCLC, chemotherapy plus intercalated EGFR-TKIs was superior to chemotherapy alone, although a definitive interpretation was jeopardized by the variable proportion of patients with EGFR mutation-positive tumors included.
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Affiliation(s)
- Anna La Salvia
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
| | - Antonio Rossi
- Division of Medical Oncology, "S. G. Moscati" Hospital, Avellino, Italy.
| | - Domenico Galetta
- Medical Oncology Department, Clinical Cancer Center Giovanni Paolo II, Bari, Italy
| | - Elisa Gobbini
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
| | - Emmanuele De Luca
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, "San Luigi Gonzaga" Hospital, Orbassano, Italy
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Mitsuoka S, Kawaguchi T, Kubo A, Isa SI, Asai K, Uji M, Watanabe T, Sawa K, Yoshimoto N, Oka T, Nakai T, Suzumura T, Tanaka H, Matsuura K, Kimura T, Yoshimura N, Kudoh S, Hirata K. Epidermal growth factor receptor tyrosine kinase inhibitors in previously treated advanced non-small-cell lung cancer with wild-type EGFR. Expert Opin Pharmacother 2016; 17:193-203. [PMID: 26781399 DOI: 10.1517/14656566.2016.1109635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION While epidermal growth factor receptor (EGFR) - tyrosine kinase inhibitors (TKIs) lead to longer progression-free survival (PFS) when compared with conventional chemotherapy in non-small-cell lung cancer (NSCLC) harboring activating EGFR mutations, the role of EGFR-TKI remains unclear in EGFR-wild-type (WT) NSCLC. AREAS COVERED This article reviews selected data from randomized trials regarding the use of TKIs in EGFR-WT NSCLC. Nine randomized phase III trials have compared EGFR-TKI with chemotherapy in NSCLC patients in a second or later line setting. Two of these trials, TAILOR and DELTA, which were designed to investigate treatment benefits according to EGFR genotype, demonstrated that docetaxel chemotherapy displayed significantly better in progression-free survival (PFS) when compared with the EGFR-TKI erlotinib. Biomarkers to predict clinical benefits of the drug against EGFR WT tumor, and the efficacy of combination regimens using erlotinib or single-use afatinib against tumors are also covered in this article. EXPERT OPINION Considering the modest benefits of erlotinib for EGFR-WT tumors, future studies are warranted, including the exploration of useful biomarkers and new treatment strategies for EGFT-TKI use, as well as the development of more sensitive EGFR mutation tests.
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Affiliation(s)
- Shigeki Mitsuoka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tomoya Kawaguchi
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Akihito Kubo
- b Department of Respiratory Medicine , Aichi Medical University School of Medicine , Aichi , Japan
| | - Shun-ichi Isa
- c Clinical Research Center , National Hospital Organization Kinki-chuo Chest Medical Center , Osaka , Japan
| | - Kazuhisa Asai
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Masato Uji
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tetsuya Watanabe
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kenji Sawa
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Naoki Yoshimoto
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Takako Oka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Toshiyuki Nakai
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tomohiro Suzumura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Hidenori Tanaka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kuniomi Matsuura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tatsuo Kimura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Naruo Yoshimura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Shinzoh Kudoh
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kazuto Hirata
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
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A phase II open-label clinical study of comparing nab-paclitaxel with pemetrexed as second-line chemotherapy for patients with stage IIIB/IV non-small-cell lung cancer. Med Oncol 2015; 32:216. [PMID: 26168982 DOI: 10.1007/s12032-015-0660-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 06/19/2015] [Indexed: 12/18/2022]
Abstract
Current choices of second-line chemotherapy regimens for patients with advanced non-small-cell lung cancer (NSCLC) are extremely limited. We applied a new strategy of using nab-paclitaxel as single chemotherapy regimen in second-line setting for patients with unsuccessful first-line chemotherapy. The efficacy and safety were compared with patients who received standard second-line regimen pemetrexed. Patients with stage IIIB/IV NSCLC and unsuccessful first-line platinum-based chemotherapy were randomly divided into two arms. Arm I received pemetrexed 500 mg/m(2) intravenously (i.v.) on day 1 of 3-week cycle. Arm II received nab-paclitaxel 150 mg/m(2) i.v. on days 1 and 8 of 3-week cycle. The primary endpoint was overall survival (OS). One hundred and eleven patients were randomly assigned to receive pemetrexed (n = 56) and nab-paclitaxel (n = 55). Median OSs were 9.4 months (95% CI 7.1-12.5 months) for pemetrexed and 9.9 months (95% CI 8.2-11.9 months) for nab-paclitaxel. Median PFS was 4.6 months (95% CI 2.7-6.1 months) for pemetrexed and 5.1 months (95% CI 3.9-7.4 months) for nab-paclitaxel. While no CR was reported for either treatment, PRs + SDs were seen in 32/56 (57.1%) patients in pemetrexed arm and 36/55 (65.5%) patients in nab-paclitaxel arm. Grade 3 and grade 4 adverse events were comparable between two treatment arms. New second-line chemotherapy single-regimen nab-paclitaxel showed equivalent efficacy and toxicity profiles as pemetrexed in treating patients with NSCLC.
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