P Neumair1, L Joos2, R Warschkow3, A Dutly4, S Ess5, F Hitz6, M Früh6, M Brutsche7, F Baty7, S Krähenbühl8, T Cerny6, M Joerger9. 1. Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland. 2. Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland; University of Basel, Basel, Switzerland. 3. Department of Surgery, Cantonal Hospital, St. Gallen, Switzerland. 4. Department of Thoracic Surgery, Cantonal Hospital, St. Gallen, Switzerland. 5. Cancer Registry St. Gallen-Appenzell, St. Gallen, Switzerland. 6. Department of Medical Oncology, Cantonal Hospital, St. Gallen, Switzerland. 7. Department of Pneumology, Cantonal Hospital, St. Gallen, Switzerland. 8. Department of Clinical Pharmacology and Toxicology, University Hospital, Basel, Switzerland. 9. Department of Medical Oncology, Cantonal Hospital, St. Gallen, Switzerland. Electronic address: markus.joerger@kssg.ch.
Abstract
OBJECTIVES: Controversy exists about the integration of erlotinib in patients with EGFR wildtype, advanced NSCLC. MATERIALS AND METHODS: We included patients with advanced NSCLC receiving at least two lines of palliative systemic treatment between January 2005 and December 2014 and not harbouring targetable driver mutations. Primary study endpoint was overall survival (OS), secondary endpoint progression-free survival (PFS). We used Kaplan-Meier statistics, multivariate Cox regression and Propensity score or Inverse Probability Weights (IPW) matching to compare clinical outcome between patients receiving erlotinib in second or further line and those receiving chemotherapy only. The study had a power of 90% to detect a survival superiority of 30%. RESULTS: From a total of 827 patients, we excluded 171 patients with potentially curative treatment, 189 receiving treatment outside of our institute, 206 receiving no or only one line of systemic treatment, 6 with ALK translocations and 28 with EGFR mutations. From 227 patients in the final efficacy analysis, 125 patients received erlotinib in second (89 patients), third (28) or further-line (8), and 102 patients received chemotherapy only. Women and never smokers were significantly overrepresented in the erlotinib group. Both OS (hazard ratio (HR)=1.14, 95% CI 0.80-1.63, P=0.448) and PFS (HR=1.20, 95% CI 0.95-1.52, P=0.119) were similar in the erlotinib compared to the chemotherapy group using IPW-adjusted Cox regression analysis treating the use of erlotinib as a time-dependent covariate starting from second-line treatment and stratified for ECOG performance status and treatment line. ECOG performance status was the most powerful covariate to select patients for erlotinib treatment. CONCLUSION: The present study suggests erlotinib to have similar clinical efficacy compared to chemotherapy in patients with pretreated advanced NSCLC and no known molecular targetable alterations.
OBJECTIVES: Controversy exists about the integration of erlotinib in patients with EGFR wildtype, advanced NSCLC. MATERIALS AND METHODS: We included patients with advanced NSCLC receiving at least two lines of palliative systemic treatment between January 2005 and December 2014 and not harbouring targetable driver mutations. Primary study endpoint was overall survival (OS), secondary endpoint progression-free survival (PFS). We used Kaplan-Meier statistics, multivariate Cox regression and Propensity score or Inverse Probability Weights (IPW) matching to compare clinical outcome between patients receiving erlotinib in second or further line and those receiving chemotherapy only. The study had a power of 90% to detect a survival superiority of 30%. RESULTS: From a total of 827 patients, we excluded 171 patients with potentially curative treatment, 189 receiving treatment outside of our institute, 206 receiving no or only one line of systemic treatment, 6 with ALK translocations and 28 with EGFR mutations. From 227 patients in the final efficacy analysis, 125 patients received erlotinib in second (89 patients), third (28) or further-line (8), and 102 patients received chemotherapy only. Women and never smokers were significantly overrepresented in the erlotinib group. Both OS (hazard ratio (HR)=1.14, 95% CI 0.80-1.63, P=0.448) and PFS (HR=1.20, 95% CI 0.95-1.52, P=0.119) were similar in the erlotinib compared to the chemotherapy group using IPW-adjusted Cox regression analysis treating the use of erlotinib as a time-dependent covariate starting from second-line treatment and stratified for ECOG performance status and treatment line. ECOG performance status was the most powerful covariate to select patients for erlotinib treatment. CONCLUSION: The present study suggests erlotinib to have similar clinical efficacy compared to chemotherapy in patients with pretreated advanced NSCLC and no known molecular targetable alterations.
Authors: Kenneth S Chen; Nicholas J Fustino; Abhay A Shukla; Emily K Stroup; Albert Budhipramono; Christina Ateek; Sarai H Stuart; Kiyoshi Yamaguchi; Payal Kapur; A Lindsay Frazier; Lawrence Lum; Leendert H J Looijenga; Theodore W Laetsch; Dinesh Rakheja; James F Amatruda Journal: Mol Cancer Ther Date: 2018-02-26 Impact factor: 6.261
Authors: Eduard Teixidor; Elia Sais; Carmen Amalia Vásquez; Walter Carbajal; Alejandro Hernández; Gloria Sánchez; Angel Izquierdo; Sara Verdura; Javier A Menéndez; Joaquim Bosch-Barrera Journal: Oncotarget Date: 2018-08-31
Authors: Tae Young Kim; Eun Sun Ji; Ju Yeon Lee; Jin Young Kim; Jong Shin Yoo; A Marcell Szasz; Balazs Dome; Gyorgy Marko-Varga; Ho Jeong Kwon Journal: Cancers (Basel) Date: 2020-09-13 Impact factor: 6.639