The Value of Early Depth of Response in Predicting Long-Term Outcome in EGFR-Mutant Lung Cancer

Abstract

The PFS advantage of EGFR-TKI over chemotherapy in advanced EGFR mutant NCLC is not explained by depth of response at 6 or 12 weeks. It should not be used as a surrogate of benefit in future trials or routine clinical decision making.

Larger tumors are associated with inferior progression‐free survival of first‐line EGFR‐tyrosine kinase inhibitors and a lower abundance of EGFR mutation in patients with advanced non‐small cell lung cancer

“…We further analyzed the depth of response to first‐line EGFR‐TKIs and median PFS and found no significant association. Our results reiterate those of two recent studies . In a study by Wu et al, although patients who achieved a partial response had significantly longer PFS and overall survival at 16.5 and 56 weeks, respectively, higher tumor shrinkage was not related to better PFS or overall survival .…”

A novel imaging biomarker for survival prediction in EGFR-mutated NSCLC patients treated with TKI

“…Our first result is that there is no correlation between volume-based imaging biomarkers and survival. This finding is consistent with the work [12] who noticed a lack of association between tumor shrinkage and long-term survival. This illustrates why the response to TKI treatment is difficult to estimate using only the evolution of tumor volume (or RECIST).…”

“…Concerning EGFR-mutated non-small cells lung carcinoma, previous works have studied the correlations between the initial reduction of the primary tumor and the overall survival. One can find contradictory results in the literature: in [10, 11], a significant correlation has been established but more recently in [12] this correlation has not be validated using another database. Many recent studies propose to use radiomic approaches which consist in extracting a large number of quantitative features from medical images using data-characterization algorithms.…”

Association between depth of response and survival in patients with advanced‐stage non–small cell lung cancer treated with first‐line chemotherapy

“…Nevertheless, DpR was not associated with PFS or OS in 2 studies involving patients with epidermal growth factor receptor ( EGFR ) mutations treated with EGFR tyrosine kinase inhibitors (TKIs) . Furthermore, in a pooled analysis involving patients with EGFR mutations enrolled in 5 randomized clinical trials comparing EGFR TKIs with chemotherapy, no association was found between DpR at 6 or 12 weeks and long‐term survival among patients treated with either an EGFR TKI or chemotherapy . There are several reasons for the discordant results between the chemotherapy arms from the pooled analysis and our study.…”

“…11,12 Furthermore, in a pooled analysis involving patients with EGFR mutations enrolled in 5 randomized Cancer July 15, 2019 clinical trials comparing EGFR TKIs with chemotherapy, no association was found between DpR at 6 or 12 weeks and long-term survival among patients treated with either an EGFR TKI or chemotherapy. 13 There are several reasons for the discordant results between the chemotherapy arms from the pooled analysis and our study. Perhaps the main differences are in methodology.…”