Oscar Arrieta1, Andrés Felipe Cardona2, Luis Corrales3, Alma Delia Campos-Parra4, Roberto Sánchez-Reyes4, Eduardo Amieva-Rivera4, July Rodríguez5, Carlos Vargas2, Hernán Carranza2, Jorge Otero2, Nikki Karachaliou6, Horacio Astudillo7, Rafael Rosell6. 1. Thoracic Oncology Unit and Experimental Oncology Laboratory, National Cancer Institute (INCan), México, D.F., Mexico. Electronic address: ogar@unam.mx. 2. Clinical and Translational Oncology Group, Institute of Oncology, Santa Fe, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia. 3. Medical Oncology, Hospital San Juan de Dios - CCSS, San José, Costa Rica. 4. Thoracic Oncology Unit and Experimental Oncology Laboratory, National Cancer Institute (INCan), México, D.F., Mexico. 5. Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia. 6. Catalan Institute of Oncology - ICO Hospital Germans Trias i Pujol, Barcelona, Spain. 7. Laboratory of Translational Cancer Research and Cellular Therapy, Oncology Hospital, Medical Center Siglo XXI, Mexico City, Mexico.
Abstract
OBJECTIVES: In non-small cell lung cancer (NSCLC), the association between common EGFR mutations (Del EX19/L858R) with EGFR tyrosine kinase inhibitors (EGFR-TKIs) has been well established. However, this has not been investigated for rare EGFR mutations or their impact on treatment response and outcome to EGFR TKIs (primary objective) and chemotherapy (secondary objective). MATERIALS AND METHODS: In an observational prospective cohort, we analyzed 188 NSCLC patients from Mexico, Colombia and Costa Rica with EGFR mutations. As a first line of treatment, 66.5% received platinum-based chemotherapy. All patients received TKIs in first-line treatment or after progression to chemotherapy. The clinical-pathological characteristics as well as the f of common and rare EGFR mutations associated with treatment response were analyzed. RESULTS: Of all patients, 79.5% had common and 20.5% had rare EGFR mutations. Lepidic and acinar adenocarcinomas were associated with common EGFR mutations (p=0.010). Patients with common EGFR mutations had higher response rates to EGFR-TKIs than those who had rare EGFR mutations (63.8 vs 32.4%, p<0.001). Women had increased progression-free survival (PFS) to EGFR-TKIs than men (16.4 vs 9.5 months, p=0.02). The median PFS and overall survival (OS) were better in patients with common EGFR mutations (15.5 vs 3.9 months, p<0.001; and 37.3 vs 17.4 months, p<0.001) respectively. CONCLUSION: Our findings suggested that only patients with rare EGFR mutations could receive platinum-based chemotherapy as a first-line treatment, due to their low response rates and short PFS in response to EGFR-TKIs. Consequently, EGFR-TKIs could be reserved as a second- or third-line treatment. In patients with EGFR mutations, women have better PFS to EGFR-TKIs than men, and rare EGFR mutations are more frequent in high grade adenocarcinomas than in low grade tumors.
OBJECTIVES: In non-small cell lung cancer (NSCLC), the association between common EGFR mutations (Del EX19/L858R) with EGFR tyrosine kinase inhibitors (EGFR-TKIs) has been well established. However, this has not been investigated for rare EGFR mutations or their impact on treatment response and outcome to EGFR TKIs (primary objective) and chemotherapy (secondary objective). MATERIALS AND METHODS: In an observational prospective cohort, we analyzed 188 NSCLCpatients from Mexico, Colombia and Costa Rica with EGFR mutations. As a first line of treatment, 66.5% received platinum-based chemotherapy. All patients received TKIs in first-line treatment or after progression to chemotherapy. The clinical-pathological characteristics as well as the f of common and rare EGFR mutations associated with treatment response were analyzed. RESULTS: Of all patients, 79.5% had common and 20.5% had rare EGFR mutations. Lepidic and acinar adenocarcinomas were associated with common EGFR mutations (p=0.010). Patients with common EGFR mutations had higher response rates to EGFR-TKIs than those who had rare EGFR mutations (63.8 vs 32.4%, p<0.001). Women had increased progression-free survival (PFS) to EGFR-TKIs than men (16.4 vs 9.5 months, p=0.02). The median PFS and overall survival (OS) were better in patients with common EGFR mutations (15.5 vs 3.9 months, p<0.001; and 37.3 vs 17.4 months, p<0.001) respectively. CONCLUSION: Our findings suggested that only patients with rare EGFR mutations could receive platinum-based chemotherapy as a first-line treatment, due to their low response rates and short PFS in response to EGFR-TKIs. Consequently, EGFR-TKIs could be reserved as a second- or third-line treatment. In patients with EGFR mutations, women have better PFS to EGFR-TKIs than men, and rare EGFR mutations are more frequent in high grade adenocarcinomas than in low grade tumors.
Authors: M E Arcila; H A Yu; J Naidoo; C S Sima; K Rodriguez; N Busby; K Nafa; M Ladanyi; G J Riely; M G Kris Journal: Cancer Date: 2015-06-10 Impact factor: 6.860
Authors: Oscar Arrieta; Pablo Anaya; Vicente Morales-Oyarvide; Laura Alejandra Ramírez-Tirado; Ana C Polanco Journal: Eur J Health Econ Date: 2015-09-04