Gefitinib or Carboplatin–Paclitaxel in Pulmonary Adenocarcinoma

Mok, Tony; Wu, Yi‐Long; Thongprasert, Sumitra; Yang, Chih Hsin; Chu, Da Tong; Saijo, Nagahiro; Sunpaweravong, Patrapim; Han, Baohui; Margono, Benjamin; Ichinose, Yukito; Nishiwaki, Yutaka; Ohe, Yuichiro; Yang, Jin; Chewaskulyong, Busyamas; Jiang, Haiyi; Duffield, Emma; Watkins, Claire; Armour, Alison; Fukuoka, Masahiro

doi:10.1056/nejmoa0810699

Cited by 7,354 publications

(6,232 citation statements)

References 29 publications

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“…Molecular therapy has become a newly emerging regimen over the last decade 4. With lesser toxicity, patients with sensitive molecular alterations could benefit more from an inhibitor therapy than traditional chemotherapy 5, 6, 7, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

Mutation and prognostic analyses of PIK3CA in patients with completely resected lung adenocarcinoma

Song

Zhang

2016

Cancer Medicine

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PIK3CA mutation represents a clinical subset of diverse carcinomas. We explored the status of PIK3CA mutation and evaluated its genetic variability, treatment, and prognosis in patients with lung adenocarcinoma. A total of 810 patients with completely resected lung adenocarcinoma were recruited between 2008 and 2013. The status of PIK3CA mutation and other three genes, that is, EGFR mutation, KRAS mutation and ALK fusion were examined by reverse transcription‐polymerase chain reaction (RT‐PCR). Survival curves were plotted with the Kaplan–Meier method and log‐rank for comparison. Cox proportional hazard model was performed for multivariate analysis. Among the 810 patients, 23 cases of PIK3CA mutation were identified with a frequency of 2.8%. There were 14 men and 9 women with a median age of 61 years. Seventeen tumors revealed concurrent gene abnormalities of EGFR mutation (n = 12), KRAS mutation (n = 3), and ALK fusion (n = 2). Seven patients with EGFR & PIK3CA mutations recurred and administrated of EGFR‐TKIs yielded a median progression free‐survival of 6.0 months. Among four eviromous‐treated patients, stable disease was observed in three patients with a median Progression‐free survival (PFS) of 3.5 months. Patients with and without PIK3CA mutation had different overall survivals (32.2 vs. 49.6 months, P = 0.003). Multivariate analysis revealed that PIK3CA mutation was an independent predictor of poor overall survival (HR = 2.37, P = 0.017). The frequency of PIK3CA mutation was around 2.8% in the Chinese patients of lung adenocarcinoma. PIK3CA mutation was associated with reduced PFS of EGFR‐TKIs treatment and shorter overall survival.

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Section: Introductionmentioning

confidence: 99%

Mutation and prognostic analyses of PIK3CA in patients with completely resected lung adenocarcinoma

Song

Zhang

2016

Cancer Medicine

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“…5,28,29,[37][38][39] Recent studies have provided more compelling evidence of the clinical benefits of anti-EGFR treatment in the appropriate setting. 13,15,22,38,[40][41][42][43][44][45][46][47][48] Evidence from the large phase III randomized Iressa Pan-Asia Study trial and other phase III trials have prompted the American Society of Clinical Oncology to issue a provisional clinical opinion recommending the testing of EGFR mutational status in patients being considered for first line EGFR TKI therapy owing to their demonstrated benefit on progression-free survival. 22,41 Of note, they caution that no definitive benefit has been shown in patients treated with first-line TKIs in regards to overall survival.…”

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confidence: 99%

Molecular pathology of lung cancer: key to personalized medicine

et al. 2012

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The majority of lung adenocarcinoma patients with epidermal growth factor receptor-(EGFR) mutated or EML4-ALK rearrangement-positive tumors are sensitive to tyrosine kinase inhibitors. Both primary and acquired resistance in a significant number of those patients to these therapies remains a major clinical problem. The specific molecular mechanisms associated with tyrosine kinase inhibitor resistance are not fully understood. Clinicopathological observations suggest that molecular alterations involving so-called 'driver mutations' could be used as markers that aid in the selection of patients most likely to benefit from targeted therapies. In this review, we summarize recent developments involving the specific molecular mechanisms and markers that have been associated with primary and acquired resistance to EGFR-targeted therapy in lung adenocarcinomas. Understanding these mechanisms may provide new treatment avenues and improve current treatment algorithms.

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“…In 2005, the Food and Drug Administration (FDA) restricted gefitinib from being used to treat all patients with NSCLC [44]. Subsequent trial evidence revealed heterogeneity in response to gefitinib that was unobserved previously, with respect to EGFR-TK mutation status [45]. The FDA and European Medicines Agency, consequently, granted marketing authorization for gefitinib in patients with NSCLC that had activating mutations of EGFR-TK [46].…”

Section: The Economic Case: In Practicementioning

confidence: 99%

The economic case for precision medicine

Gavan

Thompson

Payne

2018

Expert Review of Precision Medicine and Drug Development

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Introduction: The advancement of precision medicine into routine clinical practice has been highlighted as an agenda for national and international health care policy. A principle barrier to this advancement is in meeting requirements of the payer or reimbursement agency for health care. This special report aims to explain the economic case for precision medicine, by accounting for the explicit objectives defined by decision-makers responsible for the allocation of limited health care resources. Areas covered: The framework of cost-effectiveness analysis, a method of economic evaluation, is used to describe how precision medicine can, in theory, exploit identifiable patient-level heterogeneity to improve population health outcomes and the relative cost-effectiveness of health care. Four case studies are used to illustrate potential challenges when demonstrating the economic case for a precision medicine in practice. Expert commentary: The economic case for a precision medicine should be considered at an early stage during its research and development phase. Clinical and economic evidence can be generated iteratively and should be in alignment with the objectives and requirements of decision-makers. Programmes of further research, to demonstrate the economic case of a precision medicine, can be prioritized by the extent that they reduce the uncertainty expressed by decision-makers.

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Gefitinib or Carboplatin–Paclitaxel in Pulmonary Adenocarcinoma

Cited by 7,354 publications

References 29 publications

Mutation and prognostic analyses of PIK3CA in patients with completely resected lung adenocarcinoma

Mutation and prognostic analyses of PIK3CA in patients with completely resected lung adenocarcinoma

Molecular pathology of lung cancer: key to personalized medicine

The economic case for precision medicine

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