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Combination of EGFR-TKIs with chemotherapy versus chemotherapy or EGFR-TKIs alone in advanced NSCLC patients with EGFR mutation

Authors Wen M, Xia J, Sun Y, Wang X, Fu X, Zhang Y, Zhang Z, Zhou Y, Li X

Received 26 March 2018

Accepted for publication 11 September 2018

Published 30 November 2018 Volume 2018:12 Pages 183—190


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Doris Benbrook

Miaomiao Wen,1 Jinghua Xia,1 Ying Sun,1 Xuejiao Wang,1 Xianghui Fu,2 Yanning Zhang,1 Zhipei Zhang,1 Yongan Zhou,1 Xiaofei Li1

1Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an 710038, Shaanxi, China; 2Department of Clinical Immunology, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi, China

Purpose: Both epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and chemotherapy are widely applied for the treatment of advanced non-small-cell lung cancer (NSCLC) with EGFR mutations, and the combination of EGFR-TKIs and chemotherapy has been used for advanced NSCLC patients; however, little is known about the efficacy of the direct comparison among them.
Patients and methods: The demographic and clinical characteristics of 92 patients harboring advanced NSCLC with EGFR mutation were retrospectively reviewed. We evaluated the effects of EGFR-TKIs, chemotherapy, and EGFR-TKIs plus chemotherapy on advanced NSCLC patients with EGFR mutations, and the efficacy of combination of chemotherapy and EGFR-TKIs vs chemotherapy or EGFR-TKIs alone in advanced NSCLC patients was evaluated.
Results: The statistical results showed that the intercalated combination of EGFR-TKIs plus chemotherapy significantly improved progression-free survival (PFS; HR, 1.76; 95% CI 1.03–3.01; P=0.036; median, 20.5 vs 16 months) compared with EGFR-TKI monotherapy, but no difference in overall survival (OS) was observed between these two groups (HR, 1.52; 95% CI 0.81–2.83; P=0.19; median, 36 vs 29 months). However, patients who received the combination of chemotherapy and EGFR-TKIs had longer PFS (HR, 2.78; 95% CI 1.57–4.93; P<0.0001; median, 20.5 vs 12 months) as well as OS (HR, 2.86; 95% CI 1.56–5.27; P=0.001; median, 36 vs 18 months) than those who received chemotherapy alone. Toxicities were mild among the three treatment groups. Rash and diarrhea were common adverse events (AEs) in the EGFR-TKI group, anemia and nausea in the chemotherapy group, and anemia and diarrhea in the combination group.
Conclusion: This study demonstrated that the combination of chemotherapy with EGFR-TKIs as first-line treatment has a significant effect on PFS in patients with advanced NSCLC whose tumors harbor activating EGFR mutations. The combination treatment had more toxicity, but was clinically manageable.

Keywords: non-small-cell lung cancer, epidermal growth factor receptor-tyrosine kinase inhibitor, chemotherapy, adjuvant therapy, retrospective study

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