Efficacy of erlotinib as neoadjuvant regimen in EGFR-mutant locally advanced non-small cell lung cancer patients

Xiong, Liwen; Lou, Yu‐Qing; Bai, Hao; Li, Rong; Xia, Jinjing; Fang, Wentao; Zhang, Jie; Han‐Zhang, Han; Lizaso, Analyn; Li, Bing; Gu, Aiqin; Han, Baohui

doi:10.1177/0300060519887275

Cited by 28 publications

(42 citation statements)

References 42 publications

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“…For the comparison of the survival outcomes of neoadjuvant EGFR-TKIs versus neoadjuvant chemotherapy, Zhong et al (11) reported that the median progression-free survival (PFS) and OS were significantly longer with erlotinib than with gemcitabine plus cisplatin chemotherapy (HR, 0.39; 95% CI, 0.23 to 0.67; P < 0.001; and HR, 0.77; 95% CI, 0.41 to 1.45; P = 0.417). Similar to these results, in one excluded study, Xiong et al (12) reported that erlotinib may have a survival benefit compared with cisplatin-based doublet chemotherapy in terms of DFS (HR, 0.51; 95% CI, 0.13 to 2.01; P =0.39) and OS (HR, 0.45; 95% CI, 0.04 to 5.54; P =0.12), but a significant difference was not found. However, the chemotherapy arm in this study included vinorelbine, gemcitabine, paclitaxel, docetaxel or pemetrexed with limited participants (n=16).…”

Section: The Impact Of Neoadjuvant Egfr-tkis On Survivalsupporting

confidence: 73%

“…Since 2016, the study designs have tended to focus on NSCLC patients with stage II and stage III disease (8,9) with EGFR-sensitive mutations. In addition, a comparison of neoadjuvant EGFR-TKIs and chemotherapy (11,12) suggests that neoadjuvant EGFR-TKIs can improve patient prognosis compared with chemotherapy. Nevertheless, the chemotherapy group in the study by Zhong et al (11) was administered gemcitabine plus cisplatin, while in the study by Xiong et al (12), cisplatin-based doublet chemotherapies including vinorelbine, gemcitabine, paclitaxel, docetaxel or pemetrexed were administered.…”

Section: Introductionmentioning

confidence: 99%

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Current Evidence of the Efficacy and Safety of Neoadjuvant EGFR-TKIs for Patients With Non-small Cell Lung Cancer

et al. 2021

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PurposeEpidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have been indicated to be an effective treatment for advanced EGFR-mutant NSCLC. However, the neoadjuvant application of EGFR-TKIs in resectable NSCLC needs further investigation. Here, we aimed to evaluate the efficacy and safety of neoadjuvant EGFR-TKIs for lung cancer.MethodsPublished studies on neoadjuvant EGFR-TKIs in NSCLC were identified in PubMed, Web of Science, and EMBASE until June 1, 2020. Data on surgical rates, objective response rates (ORRs), pathologic responses, and adverse event (AE) rates were retrieved for proportional meta-analysis.ResultsIn total, 7 enrolled studies involving 129 EGFR-TKI-sensitive NSCLC patients were included in this analysis. The overall surgical rate in these studies was 95% (95% CI: 83% to 100%), with an ORR of 48% (95% CI: 39% to 57%) in the population with EGFR-TKI-sensitive mutations, whereas the ORR including wild-type EGFR patients was 28% (95% CI: 14% to 44%). The rate of grade 1-2 AEs was 69% (95% CI: 41% to 91%) but with an acceptable rate of grade 3-4 AEs of 0% (95% CI: 0% to 5%). The pooled rates of rash and diarrhea were 56% (95% CI: 31% to 79%) and 25% (95% CI: 6% to 51%), respectively. The impact of neoadjuvant EGFR-TKIs on survival remains inconclusive.ConclusionsNeoadjuvant EGFR-TKIs showed objective responses in approximately half of EGFR-sensitive NSCLC patients with a tolerable adverse effect profile. The favorable impact of neoadjuvant EGFR-TKIs on NSCLC needs more evidence for validation, such as the comparison of survival improvement between EGFR-TKIs and chemotherapy. The efficacy of neoadjuvant next-generation EGFR-TKIs in clinical trials remains unclear.

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Section: The Impact Of Neoadjuvant Egfr-tkis On Survivalsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Current Evidence of the Efficacy and Safety of Neoadjuvant EGFR-TKIs for Patients With Non-small Cell Lung Cancer

et al. 2021

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“…After surgery, 50% of patients achieved a PR, and the remaining patients achieved stable disease (SD). The median diseasefree survival (DFS) of patients who underwent surgery was 10.3 months; among the 19 patients who received neoadjuvant therapy, the progression-free survival (PFS) and the median overall survival (OS) were 11.2 and 51.6 months, respectively (1). The NCT01833572 study is a prospective single-arm phase II clinical study to evaluate the efficacy of gefitinib as a neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

A case report of right upper lung adenosquamous carcinoma resection following neoadjuvant targeted therapy

Zhang¹,

Chen²,

Guo³

et al. 2021

Ann Palliat Med

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The patient was a middle-aged male smoker who had space-occupying lesions in the right upper lung, Positron emission tomography-computed tomography (PET-CT) suggested right upper lung cancer with multiple mediastinal lymph node metastases. Endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-GS-TBLB) performed in the bronchus of the right apical segment confirmed the lesion as squamous cell carcinoma. Neoadjuvant therapy was planned. Because genetic testing revealed the epidermal growth factor receptor (EGFR) L858R mutation, the possibility of adenosquamous carcinoma was considered. The patient was clinically diagnosed with right upper lung squamous cell carcinoma c-T3N2M0, stage IIIB, and PS 1 point. Dacomitinib was selected for the targeted therapy. Eight weeks after the initiation of treatment, efficacy was assessed as a partial response (PR), suggesting a possibility of R0 resection. After sufficient communication with the patient and his family members, on July 1, 2020, thoracoscopic radical resection of the right upper lung cancer was performed under general anesthesia. Postoperative pathology confirmed adenosquamous carcinoma, of which 80% were adenocarcinoma and 20% were squamous cell carcinoma; no tumor thrombus was seen in the interstitial vessels; and the tumor did not invade the visceral pleura. There was no cancerous infiltration in the bronchial stump of the right upper lung. The following were the results for lymph nodes submitted for examination: L2 (0/1), L4 (0/4), L7 (0/3), L8 (0/7), L10 (0/1), L11 (0/2) and L11 (frozen 0/1) showed no cancer metastasis. The postoperative diagnosis was as follows: adenosquamous carcinoma of the right upper lung p-T2N0M0, stage Ib. After surgery, 4 cycles of the GC (gemcitabine + carboplatin) chemotherapy regimen were given, with continued targeted therapy recommended for 2 years. The patient has been followed-up and is in good condition.

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“…On a pathological level, 50% of patients had a partial response, while 50% had stable disease [ 26 ]. The third study compared neoadjuvant erlotinib among 15 patients whose tumors had EGFR mutations to chemotherapy in 16 patients without these alterations [ 27 ]. The authors report a trend towards better response rate, pathological response rates, and overall survival.…”

Section: Epidermal Growth Factor Receptor (Egfr) Mutationsmentioning

confidence: 99%

Targeted Therapies in Early Stage NSCLC: Hype or Hope?

Friedlaender

Addeo

Russo

et al. 2020

IJMS

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Non-small-cell lung cancer (NSCLC) represents roughly 85% of lung cancers, with an incidence that increases yearly across the world. The introduction in clinical practice of several new and more effective molecules has led to a consistent improvement in survival and quality of life in locally advanced and metastatic NSCLC. In particular, oncogenic drivers have indeed transformed the therapeutic algorithm for NSCLC. Nearly 25% of patients are diagnosed in an early stage when NSCLC is still amenable to radical surgery. In spite of this, five-year survival rates for fully resected early stage remains rather disappointing. Adjuvant chemotherapy has shown a modest survival benefit depending on the stage, but more than half of patients relapse. Given this need for improvement, over the last years different targeted therapies have been evaluated in early-stage NSCLC with no survival benefit in unselected patients. However, the identification of reliable predictive biomarkers to these agents in the metastatic setting, the design of molecularly-oriented studies, and the availability of novel potent and less toxic agents opened the way for a novel era in early stage NSCLC treatment. In this review, we will discuss the current landscape of targeted therapeutic options in early NSCLC.

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Efficacy of erlotinib as neoadjuvant regimen in EGFR-mutant locally advanced non-small cell lung cancer patients

Cited by 28 publications

References 42 publications

Current Evidence of the Efficacy and Safety of Neoadjuvant EGFR-TKIs for Patients With Non-small Cell Lung Cancer

Current Evidence of the Efficacy and Safety of Neoadjuvant EGFR-TKIs for Patients With Non-small Cell Lung Cancer

A case report of right upper lung adenosquamous carcinoma resection following neoadjuvant targeted therapy

Targeted Therapies in Early Stage NSCLC: Hype or Hope?

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