The Role of Smoking Status on the Progression-Free Survival of Non-Small Cell Lung Cancer Patients Harboring Activating Epidermal Growth Factor Receptor (EGFR) Mutations Receiving First-Line EGFR Tyrosine Kinase Inhibitor Versus Platinum Doublet Chemotherapy: A Meta-Analysis of Prospective Randomized Trials

Hasegawa, Yoshikazu; Ando, Masahiko; Maemondo, Makoto; Yamamoto, Saburo; Isa, Shun‐ichi; Sasaki, Hideo; Kubo, Akihito; Kawaguchi, Tomoya; Takada, Minoru; Rosell, Rafael; Kurata, Takeshi; Ou, Sai‐Hong Ignatius

doi:10.1634/theoncologist.2014-0285

Cited by 48 publications

(47 citation statements)

References 27 publications

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“…Previous studies have reported that patients with NSCLC harboring EGFR mutations and a positive smoking history showed a relatively low response rate, or short PFS, to EGFR-TKI therapy [21,22,23,24,25,26]. While our study was restricted to patients who received only gefitinib as EGFR-TKI therapy, in the aforementioned previous studies [9,10,11,12], EGFR-TKI therapy involved erlotinib, gefitinib or afatinib.…”

Section: Discussionmentioning

confidence: 96%

Impact of Smoking History on the Efficacy of Gefitinib in Patients with Non-Small Cell Lung Cancer Harboring Activating Epidermal Growth Factor Receptor Mutations

Igawa¹,

Sasaki²,

Otani³

et al. 2015

Oncology

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Background: Gefitinib treatment has come to be recognized as the standard therapy for patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. However, resistance to gefitinib has been observed in certain subpopulations of these patients. The purpose of this study was to evaluate the impact of smoking status on the efficacy of gefitinib in patients with NSCLC harboring EGFR mutations. Methods: The records of NSCLC patients harboring EGFR mutations who were treated with gefitinib at Kitasato University Hospital were retrospectively reviewed, and the treatment outcomes were evaluated. Results: In 153 patients with NSCLC harboring EGFR mutations, the overall response rate and progression-free survival (PFS) were 66.7% and 9.0 months, respectively. PFS differed significantly among the current smokers and never-smokers/former light smokers (10.7 vs. 5.4 months, p = 0.0002), and the response rate was significantly higher in the never-smokers/former light smokers than in the current smokers (72.3 vs. 55.8%, p = 0.04). Multivariate analysis identified smoking status as an independent predictor of PFS. Conclusion: The clinical data obtained in this study provide a valuable rationale for considering smoking status as a predictor of the efficacy of gefitinib in patients with NSCLC harboring activating EGFR mutations.

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Section: Discussionmentioning

confidence: 96%

Impact of Smoking History on the Efficacy of Gefitinib in Patients with Non-Small Cell Lung Cancer Harboring Activating Epidermal Growth Factor Receptor Mutations

Igawa¹,

Sasaki²,

Otani³

et al. 2015

Oncology

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“…Previous studies have reported that patients with NSCLC harboring activating EGFR mutations and a positive smoking history exhibit a relatively low response rate to EGFR-TKI therapy (or short PFS) [25-30]. A meta-analysis of 9 studies showed that after TKI treatment, PFS of nonsmokers was longer than in ever smokers among advanced NSCLC patients with an EGFR mutation [26].…”

Section: Discussionmentioning

confidence: 99%

Smoking History as a Predictor of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients with Non-Small Cell Lung Cancer Harboring EGFR Mutations

Nishinarita¹,

Igawa²,

Kasajima³

et al. 2018

Oncology

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Background: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKIs) therapy has been recognized as the standard treatment for patients with non-small cell lung cancer (NSCLC) harboring EGFR mutations. However, resistance to EGFR-TKIs has been observed in certain subpopulations of these patients. We aimed to evaluate the impact of smoking history on the efficacy of EGFR-TKIs. Methods: The records of patients (n = 248) with NSCLC harboring activating EGFR mutations who were treated with gefitinib or erlotinib at our institution between March 2010 and June 2016 were retrospectively reviewed, and the treatment outcomes were evaluated. Results: The overall response rate and median progression-free survival (PFS) were 59.7% and 10.7 months, respectively. The overall response rate was significantly higher in the ex- and nonsmokers than in the current smokers (64.6 vs. 51.1%, p = 0.038). PFS also differed significantly between the current smokers and the ex- and nonsmokers (12.4 vs. 7.4 months, p = 0.016). Multivariate analysis identified smoking history as an independent predictor of PFS and overall survival. Conclusion: The clinical data obtained in this study provide a valuable rationale for considering smoking history as a predictor of the efficacy of EGFR-TKI in NSCLC patients harboring activating EGFR mutations.

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“…However, in our study, EGFR mutation status had no significant effect on the clinical outcome. Also, recent metaanalyses (17,30) showed that non-smokers are likely to have a longer PFS than smokers when undergoing EGFR-TKI therapy for diagnosed EGFR-mutant NSCLC. A recent study by Mitchell et al (16) concluded that controversies in the survival outcomes of smokers versus non-smokers after EGFR-TKI therapy may be due to incomplete data on smoking history, and that its relationship with treatment response has not been comprehensively analyzed.…”

Section: Discussionmentioning

confidence: 99%

The impact of smoking status on radiologic tumor progression patterns and response to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors in lung adenocarcinoma with activating EGFR mutations

Lee

Ahn

et al. 2016

J. Thorac. Dis.

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Background: The aim of this study was to evaluate the impact of smoking on the treatment outcome of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in patients with EGFR-mutant lung adenocarcinoma, with consideration of other factors including radiologic tumor progression pattern according to patient smoking status.Methods: A total of 224 patients with EGFR mutant lung adenocarcinomas that were treated with EGFRTKIs were retrospectively reviewed. Radiologic tumor progression pattern and treatment outcomes were evaluated according to smoking history.Results: There were no significant differences in radiologic tumor progression pattern based on smoking status. There were no significant differences in survival between never-smokers and smokers or among never-, former-, and current-smokers, but there was a trend of shorter progression free survival (PFS) and poorer overall survival (OS) in smokers compared with never-smokers. In multivariate analysis, long-term smokers had shorter PFS and poorer OS than those who had never smoked.Conclusions: A history of smoking had no significant effect on radiologic tumor progression pattern; however, smoking history is a negative predictive factor of survival in patients with EGFR-mutant lung adenocarcinoma undergoing EGFR-TKI therapy.

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Cited by 48 publications

References 27 publications

Impact of Smoking History on the Efficacy of Gefitinib in Patients with Non-Small Cell Lung Cancer Harboring Activating Epidermal Growth Factor Receptor Mutations

Impact of Smoking History on the Efficacy of Gefitinib in Patients with Non-Small Cell Lung Cancer Harboring Activating Epidermal Growth Factor Receptor Mutations

Smoking History as a Predictor of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients with Non-Small Cell Lung Cancer Harboring <b><i>EGFR</i></b> Mutations

The impact of smoking status on radiologic tumor progression patterns and response to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors in lung adenocarcinoma with activating EGFR mutations

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