First-Line Erlotinib Followed by Second-Line Cisplatin-Gemcitabine Chemotherapy in Advanced Non–Small-Cell Lung Cancer: The TORCH Randomized Trial

Abstract

In unselected patients with advanced NSCLC, first-line erlotinib followed at progression by cisplatin-gemcitabine was significantly inferior in terms of overall survival compared with the standard sequence of first-line chemotherapy followed by erlotinib.

Use of the Epidermal Growth Factor Receptor Inhibitors Gefitinib, Erlotinib, Afatinib, Dacomitinib, and Icotinib in the Treatment of Non-Small-Cell Lung Cancer: A Systematic Review

“…In one trial, pfs was longer in the egfr inhibitor group: 4.57 months for erlotinib versus 2.53 months for vinorelbine (hr: 0.6444; 95% ci: 0.4325 to 0.9601; p = 0.0308) 21 . In five trials, pfs was longer in the chemotherapy group 13,15,17,19,20 . Several of the trials found that pfs significantly favoured chemotherapy 13,15,19 .…”

“…In five trials, pfs was longer in the chemotherapy group 13,15,17,19,20 . Several of the trials found that pfs significantly favoured chemotherapy 13,15,19 . One trial examined time to progression and found that it was longer with chemotherapy, but not significantly so 20 .…”

“…In one study, the response rate favoured the egfr inhibitor 21 , and in four studies, it favoured chemotherapy 13,14,[19][20][21] . The study by Reck et al 19 found a significantly higher response rate in patients randomized to chemotherapy (p = 0.0001).…”

“…Most of the trials were small, with fewer than 100 patients per arm. Only the torch trial appeared to have a sufficient number of participants to provide meaningful information on overall survival (os) 13 (Table i). The findings of the trials suggest that first-line therapy with an egfr tki is inferior to chemotherapy in an unselected population of nsclc patients.…”

Individualized treatment of NSCLC: From research to clinical practice

“…Determining optimal first-line therapy by these biomarkers is accepted as a standard for patients with NSCLC [2][3][4][5][6][7]. EGFR TKIs should be considered as the prior first-line treatments for the patients with EGFR mutation, while chemotherapy is superior to targeted therapy in the EGFR wild-type patients [8][9]. Because EGFR TKIs work only in some of the patients, the detection of EGFR mutation needs to be considered as essential routine before medication treatment.…”