Meeting
2014 ASCO Annual Meeting
A meta-analysis of smoking status on clinical outcomes of non-small cell lung cancer patients harboring activating epidermal growth factor receptor (EGFR) mutations receiving first-line EGFR tyrosine kinase inhibitor.
Authors
Yoshikazu Hasegawa
Department of Medical Oncology, Izumi Municipal Hospital, Izumi, Osaka, Japan
Yoshikazu Hasegawa , Masahiko Ando , Makoto Maemondo , Satomi Yamamoto , Shun-ichi Isa , Hideo Saka , Akihito Kubo , Tomoya Kawaguchi , Minoru Takada , Takayasu Kurata , Sai-Hong Ignatius Ou
Organizations
Department of Medical Oncology, Izumi Municipal Hospital, Izumi, Osaka, Japan, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan, Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan, Department of Lung Cancer Research, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan, Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan, Aichi Medical University School of Medicine, Nagoya, Japan, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan, Koyo Hospital, Wakayama, Japan, Department of Thoracic Oncology, Kansai Medical University Hirakata Hospital, Osaka, Japan, Chao Family Comprehensive Cancer Center, Orange, CA
Research Funding
No funding sources reported
Background: In several univariate analyses from randomized phase 3 trials, ever-smokers with advanced EGFR mutated (m) NSCLC did not seem to benefit from improved progression-free survival (PFS) even when EGFR TKIs were is used compared to doublet chemotherapy as first-line treatment. Methods: We performedpooled analysis of PFS outcome of six published randomized phase 3 trials comparing EGFR TKI to doublet chemotherapy in EGFRm NSCLC patients (WJTOG3405, NEJ002, EURTAC, OPTIMAL, LUX Lung-3, LUX Lung-6). Hazard ratio (HR) and corresponding 95% confidence interval (CI) were collected from each study published in the literature and pooled. We computed a pooled HR and its 95% CI using random-effect model. Results: 1,432 EGFRm NSCLC patient data were analyzed, 1,163 (81.2%) were Asians and 430 (30.0%) were ever-smokers. A total of 592 patients, including 178 ever-smokers (30.1%), received doublet chemotherapy and 840, including 252 (30.0%) ever-smokers, received EGFR TKI. The pooled HR for never-smokers was 0.29 (95%CI: 0.21-0.39) while the pooled HR for ever-smokers was 0.54 (95%CI: 0.38-0.76). The p-value comparing HR for never-smokers and ever-smokers by meta-regression analysis was 0.007. The pooled HR for exon 19 was 0.26 (95%CI: 0.19-0.36) while it is 0.45 for exon 21 substitution (95%CI: 0.32-0.64) with a significant difference (p = 0.019) between the two pooled HRs. The pooled HR was 0.33 (95%CI: 0.24-0.46) for Asians and 0.48 (95%CI: 0.27-0.85) for non-Asians. Asians did not derive significantly more PFS benefit than non-Asians (p = 0.256). The pooled HR for erlotinib was 0.25 (95%CI: 0.16-0.41), 0.38 (95%CI: 0.24-0.59) for gefitinib, and 0.41 (95%CI: 0.24-0.68) for afatinib. No significant differential PFS benefit was noted in any one specific EGFR TKI. Conclusions: In this meta-analysis analysis EGFRm NSCLC patients derived significant PFS benefit from TKI over chemotherapy regardless of smoking status but the PFS benefit from EGFR TKIs over chemotherapy is significantly higher in never-smokers than ever-smokers by meta-regression analysis.
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Abstract Details
Session Type
Poster Session
Session Title
Lung Cancer - Non-Small Cell Metastatic
Track
Lung Cancer
Sub Track
Metastatic Non–Small Cell Lung Cancer
Citation
J Clin Oncol 32:5s, 2014 (suppl; abstr 8101)
DOI
10.1200/jco.2014.32.15_suppl.8101
Abstract #
8101
Poster Bd #
282
Abstract Disclosures
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