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Intercalated chemotherapy and erlotinib for advanced NSCLC: high proportion of complete remissions and prolonged progression-free survival among patients with EGFR activating mutations.

Zwitter M, Stanic K, Rajer M, Kern I, Vrankar M, Edelbaher N, Kovac V - Radiol Oncol (2014)

Bottom Line: Treatment started with 3-weekly cycles of gemcitabine and cisplatin on days 1, 2 and 4 and erlotinib on days 5 to 15.After 4 to 6 cycles, patients continued with erlotinib maintenance.PET-CT scanning was performed in 30 patients and confirmed CR and PR in 16 (53.3%) and 9 (30.0%) cases, respectively.

View Article: PubMed Central - PubMed

Affiliation: Institute of Oncology Ljubljana, Ljubljana, Slovenia ; Faculty of Medicine, University of Maribor, Maribor, Slovenia.

ABSTRACT

Background: Pharmaco-dynamic separation of cytotoxic and targeted drugs might avoid their mutual antagonistic effect in the treatment of advanced non-small cell lung cancer (NSCLC).

Patients and methods: Eligible patients were treatment-naive with stage IIIB or IV NSCLC. In addition, inclusion was limited to never-smokers or light smokers or, after 2010, to patients with activating epidermal growth-factor receptor (EGFR) mutations. Treatment started with 3-weekly cycles of gemcitabine and cisplatin on days 1, 2 and 4 and erlotinib on days 5 to 15. After 4 to 6 cycles, patients continued with erlotinib maintenance.

Results: Fifty-three patients were recruited into the trial: 24 prior to 2010 (of whom 9 were later found to be positive for EGFR mutations), and 29 EGFR mutation-positive patients recruited later. Unfavourable prognostic factors included stage IV disease (51 patients - 96%), performance status 2-3 (11 patients - 21%) and brain metastases (15 patients -28%). Grade 4 toxicity included 2 cases of neutropenia and 4 thrombo-embolic events. The 15 EGFR negative patients had 33% objective response rate, median progression-free survival (PFS) 6.0 months and median survival 7.6 months. Among 38 EGFR positive patients, complete response (CR) or partial response (PR) were seen in 16 (42.1%) and 17 (44.7%) cases, respectively. PET-CT scanning was performed in 30 patients and confirmed CR and PR in 16 (53.3%) and 9 (30.0%) cases, respectively. Median PFS for EGFR mutated patients was 21.2 months and median survival was 32.5 months.

Conclusions: While patients with EGFR negative tumors do not benefit from addition of erlotinib, the intercalated schedule appears most promising for those with EGFR activating mutations.

No MeSH data available.


Related in: MedlinePlus

Waterfall plot of best percentage change in tumor size (sum of longest diameters).
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Related In: Results  -  Collection

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f1-rado-48-04-361: Waterfall plot of best percentage change in tumor size (sum of longest diameters).

Mentions: Radiologic assessment confirmed CR in 16 (42.1%) and PR in 17 (44.7%), for an overall response of 86.8%. Of the remaining five patients, four patients had minimal response or stable disease, and one had progression. Waterfall plot with the best response is shown in Figure 1.


Intercalated chemotherapy and erlotinib for advanced NSCLC: high proportion of complete remissions and prolonged progression-free survival among patients with EGFR activating mutations.

Zwitter M, Stanic K, Rajer M, Kern I, Vrankar M, Edelbaher N, Kovac V - Radiol Oncol (2014)

Waterfall plot of best percentage change in tumor size (sum of longest diameters).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230556&req=5

f1-rado-48-04-361: Waterfall plot of best percentage change in tumor size (sum of longest diameters).
Mentions: Radiologic assessment confirmed CR in 16 (42.1%) and PR in 17 (44.7%), for an overall response of 86.8%. Of the remaining five patients, four patients had minimal response or stable disease, and one had progression. Waterfall plot with the best response is shown in Figure 1.

Bottom Line: Treatment started with 3-weekly cycles of gemcitabine and cisplatin on days 1, 2 and 4 and erlotinib on days 5 to 15.After 4 to 6 cycles, patients continued with erlotinib maintenance.PET-CT scanning was performed in 30 patients and confirmed CR and PR in 16 (53.3%) and 9 (30.0%) cases, respectively.

View Article: PubMed Central - PubMed

Affiliation: Institute of Oncology Ljubljana, Ljubljana, Slovenia ; Faculty of Medicine, University of Maribor, Maribor, Slovenia.

ABSTRACT

Background: Pharmaco-dynamic separation of cytotoxic and targeted drugs might avoid their mutual antagonistic effect in the treatment of advanced non-small cell lung cancer (NSCLC).

Patients and methods: Eligible patients were treatment-naive with stage IIIB or IV NSCLC. In addition, inclusion was limited to never-smokers or light smokers or, after 2010, to patients with activating epidermal growth-factor receptor (EGFR) mutations. Treatment started with 3-weekly cycles of gemcitabine and cisplatin on days 1, 2 and 4 and erlotinib on days 5 to 15. After 4 to 6 cycles, patients continued with erlotinib maintenance.

Results: Fifty-three patients were recruited into the trial: 24 prior to 2010 (of whom 9 were later found to be positive for EGFR mutations), and 29 EGFR mutation-positive patients recruited later. Unfavourable prognostic factors included stage IV disease (51 patients - 96%), performance status 2-3 (11 patients - 21%) and brain metastases (15 patients -28%). Grade 4 toxicity included 2 cases of neutropenia and 4 thrombo-embolic events. The 15 EGFR negative patients had 33% objective response rate, median progression-free survival (PFS) 6.0 months and median survival 7.6 months. Among 38 EGFR positive patients, complete response (CR) or partial response (PR) were seen in 16 (42.1%) and 17 (44.7%) cases, respectively. PET-CT scanning was performed in 30 patients and confirmed CR and PR in 16 (53.3%) and 9 (30.0%) cases, respectively. Median PFS for EGFR mutated patients was 21.2 months and median survival was 32.5 months.

Conclusions: While patients with EGFR negative tumors do not benefit from addition of erlotinib, the intercalated schedule appears most promising for those with EGFR activating mutations.

No MeSH data available.


Related in: MedlinePlus