EGFR Mutation Impact on Definitive Concurrent Chemoradiation Therapy for Inoperable Stage III Adenocarcinoma

Tanaka, Kosuke; Hida, Toyoaki; Oya, Yuko; Oguri, Tomoyo; Yoshida, Tatsuya; Shimizu, Junichi; Horio, Yoshitsugu; Hata, Akito; Kaji, Ryuji; Fujita, Shiro; Sekido, Yoshitaka; Kodaira, Takeshi; Kitajima, Masaki; Katakami, Nobuyuki; Yatabe, Yasushi

doi:10.1097/jto.0000000000000675

Cited by 57 publications

(84 citation statements)

References 24 publications

(27 reference statements)

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“…A total of seven retrospective studies were identified [ 22 – 28 ]. RT was used as the only preoperative therapy in one study, which was thus excluded from further analysis [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

The impact of epidermal growth factor receptor mutations on patterns of disease recurrence after chemoradiotherapy for locally advanced non–small cell lung cancer: a literature review and pooled analysis

Ochiai

Nomoto

Watanabe

et al. 2016

Journal of Radiation Research

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The purpose of this review was to evaluate the impact of epidermal growth factor receptor (EGFR) mutation status on disease recurrence in patients treated with chemoradiotherapy (CRT) for locally advanced non–small cell lung cancer (NSCLC). A literature search was conducted and a total of three studies were analyzed. There was no significant difference in the objective response rate between the EGFR mutation group and the EGFR wild-type group (odds ratios [OR] 1.46, 95% CI, 0.79–2.70, P = 0.228), and there was no significant difference in the incidence of disease recurrence (OR 1.37, 95% CI, 0.68–2.75, P = 0.379) between the two groups. There were significant difference in the incidence of local/locoregional progression (LP) (OR 0.35, 95% CI, 0.18–0.71, P = 0.003) and distant progression (DP) (OR 2.97, 95% CI, 1.59–5.54, P < 0.001). Brain metastasis (BM) was one of the main recurrence patterns of DP, and the incidence was significantly higher in the EGFR mutant group (OR 2.75, 95% CI, 1.43–5.31, P = 0.003). There were no statistically significant heterogeneities in these pooled analyses. The patterns of recurrence after CRT for locally advanced NSCLC were different according to EGFR mutation status. LP after CRT in patients with EGFR mutation was less frequent, but the high incidence of DP, especially BM, continued to be the major problem. On the other hand, LP continued to be the major problem in EGFR wild-type patients. In multimodality treatment for inoperable locally advanced NSCLC, we may need to consider different treatment strategies according to EGFR mutation status.

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“…A total of seven retrospective studies were identified [ 22 – 28 ]. RT was used as the only preoperative therapy in one study, which was thus excluded from further analysis [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

The impact of epidermal growth factor receptor mutations on patterns of disease recurrence after chemoradiotherapy for locally advanced non–small cell lung cancer: a literature review and pooled analysis

Ochiai

Nomoto

Watanabe

et al. 2016

Journal of Radiation Research

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“…26,27 Ochiai et al 26 found no differences in the objective response rate (odds ratio 1.46, 95% CI 0.79-2.70) or the disease recurrence rate (odds ratio 1.37, 95% CI 0.68-2.75) after CRT between the EGFRm+ and EGFR wild-type groups. On the other hand, Tanaka et al 27 reported that PFS was significantly shorter in the EGFRm+ group and that the ratio of distant metastasis in patients with disease recurrence was relatively higher in this group than the EGFR wild-type group. We also observed a higher ratio of distant metastasis in the EGFRm+ group than the EGFRm−/unknown group.…”

Section: Discussionmentioning

confidence: 98%

Real‐world outcomes of chemoradiotherapy for unresectable Stage III non‐small cell lung cancer: The SOLUTION study

et al. 2020

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There are limited real‐world data on the treatment practices, outcomes, and safety of chemoradiotherapy (CRT) alone in potential candidates for immune checkpoint inhibitors (ICI) for unresectable non‐small cell lung cancer (NSCLC). In this study, we analyzed the safety and efficacy of CRT in patients who underwent CRT and would satisfy the key eligibility criteria for maintenance therapy with durvalumab (eg, no progression after CRT) in real‐world settings (m‐sub) for unresectable Stage III NSCLC between 1 January 2013 and 31 December 2015 at 12 sites in Japan. The m‐sub comprised 214 patients with a median follow‐up of 31.6 months (range 1.9‐65.8 months). Median overall survival (OS) and progression‐free survival (PFS) from completing CRT were 36.4 months (95% confidence interval [CI] 28.1 months to not reached) and 9.5 months (95% CI 7.7‐11.7 months), respectively. Consolidation chemotherapy did not influence OS or PFS. Median PFS was 16.9 vs 9.1 months in patients with vs without epidermal growth factor receptor (EGFR) mutations, with PFS rates of ~20% at 3‐4 years. Pneumonitis was the most common adverse event (according to MedDRA version 21.0J), and about half of events were grade 1. Pneumonitis mostly occurred 10‐24 weeks after starting CRT, peaking at 18‐20 weeks. Esophagitis and dermatitis generally occurred from 0 to 4 weeks, peaking at 2‐4 weeks after starting CRT. Pericarditis was rare and occurred sporadically. In conclusion, the results of the m‐sub provide real‐world insight into the outcomes of CRT, and will be useful for future evaluations of ICI maintenance therapy after CRT.

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“…In the present study PFS was shorter and recurrence rate was higher in the EGFR mutant group, which was inconsistent with data from previous studies. Only one study, Tanaka et al (18), demonstrated that the PFS was shorter and 2-year recurrence-free survival rate was poorer in the EGFR mutant group. Notably, the recurrence patterns in these studies subsequent to cCRT in LA-NSCLC setting were similar to those of the present study, which demonstrated that the EGFR mutant groups exhibited lower loco-regional recurrence rate (15,16,18).…”

Section: Discussionmentioning

confidence: 99%

“…Only one study, Tanaka et al (18), demonstrated that the PFS was shorter and 2-year recurrence-free survival rate was poorer in the EGFR mutant group. Notably, the recurrence patterns in these studies subsequent to cCRT in LA-NSCLC setting were similar to those of the present study, which demonstrated that the EGFR mutant groups exhibited lower loco-regional recurrence rate (15,16,18). Preclinical studies have demonstrated that NSCLC cell lines with EGFR mutations exhibit greater radiosensitivity compared with those without EGFR mutation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of concurrent chemoradiotherapy for locally advanced NSCLC according to EGFR mutation status

et al. 2017

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Abstract. Concurrent chemoradiotherapy (cCRT) is the standard treatment for patients with locally advanced non-small cell lung cancer (LA-NSCLC). However, the efficacy and safety of this treatment has not been compared between patients who possess epidermal growth factor receptor (EGFR) mutations and patients with wild-type EGFR. The objective of the present study was to evaluate the effect of the presence of EGFR gene mutations in patients with LA-NSCLC receiving cCRT. Between January 2007 and December 2013, the records of 64 patients were reviewed retrospectively. The data were statistically analyzed to evaluate the efficacy of cCRT according to EGFR mutation status. In total, 15/64 were revealed to possess EGFR mutations, 23%, and comprised the mutant EGFR group. The progression-free survival time was significantly shorter in the mutant EGFR group compared with the patient group with tumors exhibiting wild-type EGFR, 6.3 and 9.5 months, respectively (P<0.001). The overall survival rate was longer in the mutant EGFR group compared with the wild-type EGFR group, although the difference was not statistically significant, 37.1 and 21.1 months, respectively (P=0.26). The disease recurred in all of the patients of the mutant EGFR group, whilst the recurrence rate in the wild-type EGFR group was 89%. The frequency of distant metastasis was significantly higher in the mutant EGFR group compared with the wild-type EGFR group. In conclusion, these data suggest that additional studies are required to identify strategies for reinforcing the efficacy of cCRT, with a focus on the potential use of EGFR tyrosine kinase inhibitors for patients exhibiting an EGFR mutation.

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EGFR Mutation Impact on Definitive Concurrent Chemoradiation Therapy for Inoperable Stage III Adenocarcinoma

Cited by 57 publications

References 24 publications

The impact of epidermal growth factor receptor mutations on patterns of disease recurrence after chemoradiotherapy for locally advanced non–small cell lung cancer: a literature review and pooled analysis

The impact of epidermal growth factor receptor mutations on patterns of disease recurrence after chemoradiotherapy for locally advanced non–small cell lung cancer: a literature review and pooled analysis

Real‐world outcomes of chemoradiotherapy for unresectable Stage III non‐small cell lung cancer: The SOLUTION study

Evaluation of concurrent chemoradiotherapy for locally advanced NSCLC according to EGFR mutation status

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