Journal Article

Concurrent chemotherapy and first‐generation epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors (TKIs) with or without an antiangiogenic agent as first‐line treatment in advanced lung adenocarcinoma harboring an EGFR mutation

Xing, Puyuan, Li, Junling, Xu, Ziyi, Lin, Lin, Hao, Xuezhi

2021

Overview

Background Previous studies have demonstrated the combination of epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors (TKIs) and other antitumor agents may delay drug resistance. In this study, we retrospectively reviewed the efficacy and safety of first‐line concurrent EGFR‐TKIs and platinum‐based doublet chemotherapy with or without an antiangiogenic agent for advanced lung adenocarcinoma patients in the real world. Methods A total of 30 patients with advanced lung adenocarcinoma and activating EGFR mutations concurrently received an EGFR‐TKI and platinum‐based doublet chemotherapy with or without bevacizumab. The safety profile and efficacy were retrospectively reviewed. Results At the median follow‐up time of 22.1 months, 18 patients had experienced disease progression, and six patients had died because of disease. The median progression‐free survival (mPFS) was 21.2 months (95% CI: 12.631–29.798). Of the 28 patients who had measurable lesions, the objective response rate and disease control rate were 71.4% and 96.4%, respectively (one patient achieved complete remission, 19 patients had a partial response and seven patients had stable disease). Male patients had significantly longer mPFS than female patients (32.6 vs. 14.6 months, HR = 3.593, 95% CI: 1.158–11.148, p = 0.027). The most frequently seen grade 3/4 adverse events were hematological toxicities, seen in three cases (10%). Three patients ceased bevacizumab due to vascular events, including hypertension (grade 2, 6.7%) and venous thrombosis (grade 2, 3.3%), and continued EGFR‐TKI and platinum‐based doublet chemotherapy. Conclusions The combination of first‐generation EGFR‐TKIs with platinum‐based chemotherapy may be a first‐line treatment for advanced lung adenocarcinoma patients harboring activated EGFR mutations and is well tolerated. Previous studies have demonstrated that the combination of epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors (TKIs) and other antitumor agents may delay drug resistance. As results of phase III trial JMIT and NEJ009 indicated, the combination therapy of EGFR‐TKI and chemotherapy benefited NSCLC patients who harbored EGFR sensitive mutations as first‐line therapy. This study has provided further evidence for the efficacy and safety of concurrent use of EGFR‐TKI and platinum‐based chemotherapy as a first‐line therapy for advanced lung adenocarcinoma patients with EGFR 19 del or 21 L858R mutation in the real world. We also explored the relationship between EGFR mutation type and efficacy of the combination strategy. In conclusion, we determined that the combination strategy is promising as first‐line treatment for advanced lung adenocarcinoma patients harboring activated EGFR mutations, and is well‐tolerated.

• Publisher: John Wiley & Sons Australia, Ltd,John Wiley & Sons, Inc,Wiley
• Subject: Adenocarcinoma of Lung - drug therapy / Adenocarcinoma of Lung - genetics / Adult / advanced lung adenocarcinoma / Aged / Angiogenesis Inhibitors - therapeutic use / Antineoplastic Agents - therapeutic use / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Bevacizumab - therapeutic use / Cancer therapies / Chemotherapy / concurrent therapy / Drug Therapy, Combination / Epidermal growth factor / epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitor (TKI) / ErbB Receptors - antagonists & inhibitors / ErbB Receptors - genetics / Family medical history / Female / first‐line therapy / Genes / Humans / Lung cancer / Lung Neoplasms - drug therapy / Lung Neoplasms - genetics / Male / Middle Aged / Monoclonal antibodies / Mutation / Original / Patients / Platinum / platinum‐based doublet chemotherapy / Protein Kinase Inhibitors - therapeutic use / Retrospective Studies