Neoadjuvant Erlotinib Improves PFS in mutated-NSCLC

By David Costill
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A presentation at ESMO Congress 2018 in Munich determined that neoadjuvant erlotinib benefited a subset of patients with early-stage EGFR-mutated non-small cell lung cancer.

“Our results suggest promise for the use of biomarker-guided neoadjuvant EGFR-tyrosine kinase inhibitor (TKI) treatment strategies in stage IIIA-N2 non-small cell lung cancer,’ Yi-Long Wu, MD, professor at the Guangdong Lung Cancer Institute, in China, said in a press release. “This is the first study to demonstrate progression-free survival (PFS) superiority for erlotinib over gemcitabine plus cisplatin chemotherapy in the neoadjuvant/adjuvant setting of stage IIIA-N2 EGFR mutated NSCLC.”


​Photos courtesy of ESMO.

The researchers conducted a randomized trial comparing erlotinib with gemcitabine plus cisplatin as neoadjuvant treatment. They studied 386 patients with early-stage EGFR-mutated NSCLC from 17 medical centers in China. 72 patients were randomized to a 1:1 matched cohort.

Study results demonstrated that the objective response rate was 54.1% in the neoadjuvant erlotinib group and 34.3% in the gemcitabine plus cisplatin chemotherapy group. Further, the researchers found that median progression-free survival was longer in the neoadjuvant erlotinib, at 21.5 months, compared with 11.9 months in the gemcitabine plus cisplatin chemotherapy group (P = .0003).

“Cisplatin-based doublet chemotherapy as neoadjuvant treatment for stage IIIA-N2 NSCLC only gives patients 5% five-year overall survival benefit,” Wu concluded. “Recently, the CTONG 1104 trial showed for the first time that adjuvant EGFR-TKI gefitinib could improve disease free survival by 10 months compared to adjuvant chemotherapy (28.7 months vs 18.0 months) in N1N2 resected NSCLC. This raises the possibility that EGFR-TKIs may play a beneficial role in the neoadjuvant setting for this subgroup.”