Meeting
2015 ASCO Annual Meeting
The impact on overall survival (OS) of first-line gefitinib (G) and erlotinib (E) and of clinical factors in advanced non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor mutations (EGFR mut) based on meta-analysis of 1,231 patients (pts) enrolled in 6 major randomized trials.
Authors
Chee Lee
NHMRC Clinical Trials Centre, Sydney, Australia
Chee Lee , Lucy Claire Davies , Yi-Long Wu , Tetsuya Mitsudomi , Akira Inoue , Rafael Rosell , Caicun Zhou , Kazuhiko Nakagawa , Sumitra Throngprasert , Masahiro Fukuoka , Richard J. Gralla , Val Gebski , Tony Mok , James Chih-Hsin Yang
Organizations
NHMRC Clinical Trials Centre, Sydney, Australia, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia, Guangdong Lung Cancer Institute, Guangdong General Hospital (GGH) and Guangdong Academy of Medical Sciences, Guangzhou, China, Kinki University School of Medicine, Osaka-Sayama, Japan, Tohoku University Hospital, Sendai-Shi, Japan, Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain, Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Tongji University Medical School Cancer Institute, Shanghai, China, Kinki University Facultyof Medicine, Osakasayama, Japan, Chiang Mai University, Chiang Mai, Thailand, Izumi Municipal Hospital, Izumi City, Japan, Albert Einstein College of Medicine - Jacobi Medical Center, Bronx, NY, Chinese University of Hong Kong, Shatin, Hong Kong, Department of Oncology, National Taiwan University Hospital; Graduate Institute of Oncology & Cancer Research Center, National Taiwan University, Taipei, Taiwan
Research Funding
No funding sources reported
Background: We performed an individual pts data meta-analysis using trials that compared G or E vs platinum doublet chemotherapy (CT) on OS outcome. Methods: Treatment-naïve pts with common EGFR mut (Del19 or L858R), stage IIIB/IV/post-operative recurrence were randomized to either G (IPASS, NEJ002, WJTOG3405) or E (ENSURE, EURTAC, OPTIMAL) vs CT. We performed Cox regression to obtain hazard ratios (HR) and 95% confidence intervals (CI) for the overall population and pre-specified subgroups. We calculated pooled treatment estimate using the inverse variance weighted method. Results: Amongst 1231 pts (Del19 = 682, L858R = 540, Del19 and L858R = 9), 632 received EGFR tyrosine kinase inhibitor (TKI) and 599 received CT. The median follow-up was 35.0 months, and 780 (63%) pts had died. Following progression, 74% (CT group) received EGFR-TKI and 66% (EGFR-TKI group) received CT. There was no difference in OS between EGFR-TKI and CT (median 25.8 vs 26.0 months, HR = 1.01 [CI 0.88-1.17; P = 0.84]). There was no significant difference between Del19 (HR = 0.96, CI 0.79-1.16, P = 0.64) and L858R (HR = 1.06, CI 0.86-1.32; P = 0.59) subgroups (P-interaction = 0.47). There was also no significant difference according to smoking status (P-interaction = 1.00), sex (P-interaction = 0.80), performance status (P-interaction = 0.88), age (P-interaction = 0.61), ethnicity (P-interaction = 0.63), histology (P-interaction = 0.84), and staging (P-interaction = 0.43). Performance status (0 vs 1 vs 2: median 34.0 vs 24.1 vs 15.7 months, P-logrank < 0.001) and staging (IV vs IIIB vs post-operative recurrence: median 23.9 vs 31.0 vs 42.7 months, P-logrank < 0.001) were prognostic for OS. Conclusions: Despite significant PFS benefit, there is no OS difference with first-line G or E when compared with CT in advanced NSCLC with common EGFR mut, probably due to high rate of cross-over at progression. There is no significant difference in EGFR-TKI treatment benefit in all subgroups. Poor performance status and stage IV cancer are associated with poorer OS.
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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 33, 2015 (suppl; abstr 8072)
DOI
10.1200/jco.2015.33.15_suppl.8072
Abstract #
8072
Poster Bd #
395
Abstract Disclosures
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