Delay of treatment change after objective progression on first-line erlotinib in epidermal growth factor receptor-mutant lung cancer.
Delay of treatment change after objective progression on first-line erlotinib in epidermal growth factor receptor-mutant lung cancer.
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DOI：
10.1002/cncr.29397
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发表时间：
2015-08-01
期刊：
影响因子：
6.2
通讯作者：
Oxnard GR
中科院分区：
文献类型：
--
作者：
Lo PC;Dahlberg SE;Nishino M;Johnson BE;Sequist LV;Jackman DM;Jänne PA;Oxnard GR
Erlotinib is a highly active EGFR kinase inhibitor approved for first-line use in lung cancers harboring EGFR mutations. Anecdotal experience suggests this drug may provide continued disease control following objective progression of disease (PD), however this has not been systematically studied. Patients with RECIST-defined PD on three prospective trials of first-line erlotinib in advanced lung cancer were studied retrospectively, comparing progression characteristics of cases with and without EGFR sensitizing mutations. Factors influencing time to treatment change (TTC), defined as the time from PD until start of a new systemic therapy or death, were studied. Rate of tumor progression was assessed by comparing tumor measurements between the PD scan and the preceding scan. 92 eligible patients were studied: 42 with an EGFR sensitizing mutation and 50 without. The EGFR-mutant cohort had a slower rate of progression (p = 0.003) and a longer TTC (p < 0.001). Among EGFR-mutant cancers, 28 (66%) continued single-agent erlotinib following PD and 21 (50%) were able to delay change in systemic therapy for >3 months; only 2 received local debulking therapy during that period. Multivariate analysis of EGFR-mutant cases demonstrated that longer time to progression, slower rate of progression, and lack of new extrathoracic metastases were associated with a longer TTC. A change in systemic therapy can commonly be delayed in patients with EGFR-mutant lung cancer objectively progressing on first-line erlotinib, particularly in those with a longer time to progression, a slow rate of progression, and lack of new extrathoracic metastases.
