IRCCS-Mario Negri Institute, Milano, Italy
Valter Torri , Masahiko Ando , Eliana Rulli , Irene Claudia Floriani , Tomoya Kawaguchi , Shun-ichi Isa , Vanesa Gregorc , Silvia Novello , Sandro Barni , Michela Cinquini , Silvia Marsoni , Gabriella Farina , Marina Chiara Garassino
Background: While the benefit of EGFR tyrosine kinase inhibitors in EGFR mutated NSCLC patients (pts) is undisputed, their usefulness in wtEGFR pts is still questioned. The TAILOR, DELTA and PROSE trials singularly showed a significant gain in Progression-Free Survival (PFS) favoring CT. We present here the mature results from the IPD analysis of the three studies. Methods: In each trial, pts with wtEGFR stage IIIB/IV NSCLC, progressing after first line platinum-based therapy, were randomized 1:1 to receive either E or CT at standard doses. Primary endpoints of this IPD were PFS and Overall Survival (OS); summary measures were Hazard Ratio (HR) and Difference in Mean Survival Time (DMST), which is the difference in the areas under the Kaplan-Meier curves of two treatment arms. Cox regression analyses were used to estimate the HR. All analyses were stratified by trial. Results: The analysis included all 587 pts randomized into the trials (Overall E/CT 303/284; TAILOR 109/110; DELTA 109/90; PROSE 85/84); 464 deaths and 570 progressions or deaths were observed. Compared with CT, E treatment was associated to an increased risk of both progression (40%) and death (12%) (HR-PFS: 1.40, 95%CI: 1.18-1.65, p < 0.0001; HR-OS: 1.12, 95%CI: 0.93-1.35; p = 0.221). Importantly, patients treated with CT gained 1.6 and 1.5 months, in progression-free and life-time respectively (DMST-PFS 95%CI: 0.6-2.1; DMST-OS 95%CI: -0.5-3.4). Results were preserved after adjustment by age, gender, smoking habit, performance status and histotype. Conclusions: The IPD analysis of TAILOR, DELTA and PROSE conclusively confirm the superiority of CT over E in the disease control of wtEGFR NSCLC patients, and corroborate the original results of each single trial.
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