By Will Boggs MD
NEW YORK (Reuters Health) - 29/8/2019
EGFR tyrosine kinase inhibitors (TKIs) added to chemotherapy prolong overall and disease-free survival (DFS) in patients with resected non-small cell lung cancer (NSCLC) bearing EGFR mutations, researchers in China report.
"EGFR TKIs have been the standard preferred treatment in EGFR-mutated metastatic non-small-cell lung cancer," Dr. Peng Xie from Shandong Cancer Hospital and Institute, in Jinan, told Reuters Health by email. "Our study showed that EGFR TKIs can also be favored in postoperative NSCLC."
Dr. Xie and colleagues evaluated the effect of EGFR TKIs as adjuvant therapy for EGFR-mutated NSCLC patients after surgery in their meta-analysis of 11 trials that had completed accrual from 2005 to 2018.
Meta-analysis of nine studies including a total of 980 patients found that EGFR TKIs (with or without chemotherapy) significantly improved the odds of overall survival, compared with no TKIs (placebo or chemotherapy).
In subgroup analyses, four trials of 471 patients found no benefit of EGFR TKI monotherapy over single-agent chemotherapy, but EGFR TKIs plus concurrent chemotherapy significantly improved the odds of overall survival versus chemotherapy alone.
In 11 studies of 1,152 patients, EGFR TKIs improved the odds of DFS over that of therapies without TKIs, and subgroup analyses demonstrated the superiority of EGFR TKI monotherapy over chemotherapy alone and the superiority of EGFR TKIs plus concurrent chemotherapy over chemotherapy alone.
The odds of experiencing severe adverse events was 78% lower with EGFR TKI monotherapy than with chemotherapy, and EGFR TKIs did not increase toxicity when combined with chemotherapy, the researchers report in Lung Cancer, online August 2.
"It is our responsibility to try best to prolong patients' long-term survival and prevent patients from severe adverse events," Dr. Xie said. "EGFR TKIs as adjuvant therapy may be a better method to prevent the recurrence of lung cancer than conventional chemotherapy. Therefore, maybe it is time to abandon blindly conventional adjuvant chemotherapy, at least in some patients."
The study had no commercial funding, and the authors report no conflicts of interest.
Lung Cancer 2019.
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