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Delay of treatment change after objective progression on first‐line erlotinib in epidermal growth factor receptor‐mutant lung cancer
Author(s) -
Lo Peter C.,
Dahlberg Suzanne E.,
Nishino Mizuki,
Johnson Bruce E.,
Sequist Lecia V.,
Jackman David M.,
Jänne Pasi A.,
Oxnard Geoffrey R.
Publication year - 2015
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29397
Subject(s) - erlotinib , medicine , epidermal growth factor receptor , lung cancer , oncology , tumor progression , erlotinib hydrochloride , cancer , kras , debulking , progression free survival , chemotherapy , ovarian cancer , colorectal cancer
BACKGROUND Erlotinib is a highly active epidermal growth factor receptor (EGFR) kinase inhibitor that is approved for first‐line use in lung cancers harboring EGFR mutations. Anecdotal experience suggests that this drug may provide continued disease control after patients develop objective progression of disease (PD), although this has not been systematically studied to date. METHODS Patients who had Response Evaluation Criteria In Solid Tumors‐defined PD who were participating in 3 prospective trials of first‐line erlotinib in advanced lung cancer were studied retrospectively, and the progression characteristics were compared between patients with and without EGFR ‐sensitizing mutations. Factors were studied that influenced the time until treatment change (TTC), defined as the time from PD to the start of a new systemic therapy or death. The rate of tumor progression was assessed by comparing tumor measurements between the computed tomography scan obtained at the time of PD and the preceding scan. RESULTS In total, 92 eligible patients were studied, including 42 with and 50 without an EGFR ‐sensitizing mutation. The EGFR ‐mutant cohort had a slower rate of progression ( P = .003) and a longer TTC ( P < .001). Among the patients with EGFR ‐mutant cancers, 28 (66%) continued single‐agent erlotinib after PD, and 21 (50%) were able to delay a change in systemic therapy for >3 months; only 2 patients received local debulking therapy during that period. Multivariate analysis of the patients with EGFR ‐mutant tumors demonstrated that a longer time to progression, a slower rate of progression, and a lack of new extrathoracic metastases were associated with a longer TTC. CONCLUSIONS A change in systemic therapy commonly can be delayed in patients with EGFR ‐mutant lung cancer who objectively progress on first‐line erlotinib, particularly in those with a longer time to progression, a slow rate of progression, and a lack of new extrathoracic metastases. Cancer 2015;121:2570–2577 . © 2015 American Cancer Society .