Lung cancer is the leading cause of cancer-related mortality worldwide. Chemotherapy and EGFR TKI combinations may be possible treatment options for patients with NSCLC and activating EGFR mutations. Many clinical trials have shown the potential benefits of these combinations.The addition of chemotherapy to first - and second - generation tyrosine kinase inhibitors significantly improved PFS compared with tyrosine kinase inhibitors monotherapy in treatment- naive patients with EGFR-mutated advanced NSCLC.We undertook the open prospective non-randomized multi -center study in a similar patient population.
We recruited patients with advanced NSCLC harboring EGFR mutations. Initially there were two months of treatment by gefitinib 250 mg daily. Then, after a 2-week drug-free period, 3 cycles of paclitaxel 175 mg / m2 and carboplatin AUC5 were administrated at days 71-113. Thereafter, gefitinib was re-started on day 135 and continued until disease progression. The primary endpoint was progressive free survival (PFS) time.
From May 2016 to May 2018, 54 patients with advanced (IIIB / IV stages) NSCLC, with activating mutation of the EGFR gene in exon 19 or 21, were included in the study. The objective response rate (ORR) was 55,5%. Serious adverse events were reported by 4 (7,4%) of 54 patients. 2-year PFS in all patients group included in the study at the time of the preliminary analysis was 38.9%, median PFS was 20,0 months (16.0–23,9CI 95%). Median overall survival was not reached.
Integrated chemotherapy with first - and second - generation tyrosine kinase inhibitors is a viable first-line option for patients with non-small-cell lung cancer with EGFR mutation-positive disease, wich can help overcome acquired resistance to tyrosine kinase inhibitors. Tretment benefit of integrated chemotherapy compared with monotherapy of tyrosine kinase inhibitors 1-2 generations is obvious when comparing the results of our study with the data of randomized trials devoted to this problem.
K. Laktionov.
Has not received any funding.
All authors have declared no conflicts of interest.