Phase II study of gefitinib and inserted cisplatin plus docetaxel as a first-line treatment for advanced non-small cell lung cancer haboring an epidermal growth factor receptor activating mutation.

Authors

null

Shintaro Kanda

Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan

Shintaro Kanda , Yuichiro Ohe , Hidehito Horinouchi , Yutaka Fujiwara , Hiroshi Nokihara , Noboru Yamamoto , Ikuo Sekine , Hideo Kunitoh , Kaoru Kubota , Tomohide Tamura

Organizations

Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan, Division of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan, Department of Medical Oncology, Chiba Universtiy, Chiba, Japan, Department of Respiratory Medicine, Mitsui Memorial Hospital, Tokyo, Japan, Division of Pulmonary Medicine, Infection and Oncology, Department of Internal Medicine, Nippon Medical School Hospital, Tokyo, Japan

Research Funding

Other

Background: Gefitinib yields a longer progression-free survival (PFS) period than platinum–doublet chemotherapy as a first–line treatment for patients with advanced non–small–cell lung cancer (NSCLC) harboring an epidermal growth factor receptor (EGFR) activating mutation, but most patients develop resistance against gefitinib after the initial response. We hypothesized that the insertion of platinum–doublet chemotherapy during the initial response could prevent the emergence of acquired resistance and prolong survival, compared with gefitinib alone. Methods: We performed a phase ΙΙ study of the following first–line treatment for patients with advanced NSCLC with EGFR mutation. Gefitinib (250 mg) was administrated on days 1–56. After a two–week rest, three cycles of cisplatin (80 mg/m2) and docetaxel (60 mg/m2) were administered on days 71, 92, and 113. Gefitinib was re–started on day 134 and was continued until progression. The primary endpoint was the two–year PFS rate. The sample size was estimated at 33, and this treatment was considered worthy for further development if more than 11 of the 33 patients who started treatment had a 2–year PFS. Results: Thirty–three Japanese patients were enrolled. Twenty–five patients could re–start gefitinib, 12 achieved a PFS period of over 2 years, and 9 continued to receive the protocol treatment without experiencing progression. The 1–, 2–, and 3–year estimated PFS rates were 59.4%, 37.5%, and 33.8%, respectively, and the median PFS time was 19.2 months. The 1–, 2–, and 3–year estimated survival rates were 90.0%, 82.9%, and 62.4%, respectively, and the median survival time had not been reached at the time of analysis. Treatment–related deaths and unexpected severe toxicities were not seen. Conclusions: Our results indicated that first–line treatment consisting of gefitinib and inserted cisplatin plus docetaxel is promising for patients with advanced NSCLC with EGFR mutation. A phase ΙΙΙ study of this treatment compared with gefitinib alone is warranted. Clinical trial information: 000001738.

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Abstract Details

Meeting

2013 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer - Non-small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Clinical Trial Registration Number

000001738

Citation

J Clin Oncol 31, 2013 (suppl; abstr 8064)

DOI

10.1200/jco.2013.31.15_suppl.8064

Abstract #

8064

Poster Bd #

35D

Abstract Disclosures