Selection of non-small cell lung cancer patients for intercalated chemotherapy and tyrosine kinase inhibitors

Matjaž Zwitter (Author), Antonio Rossi (Author), Massimo Di Maio (Author), Maja Pohar Perme (Author), Gilberto Lopes (Author)

Abstract

Background. When treating patients with advanced non-small cell lung cancer (NSCLC) with tyrosine kinase inhibitors and chemotherapy, intercalated schedule with time separation between the two classes of drugs should avoid their mutual antagonism. In a survey of published trials, we focus on relation between eligibility criteria and effectiveness of intercalated treatment. Methods. Published documents were identified using major medical databases, conference proceedings and references of published trials. Median progression-free survival (PFS) was taken as the basic parameter of treatment efficacy. Correlation between characteristics of patients and median PFS was assessed through the Pearson%s correlation coefficient and the coefficient of determination, separately for first-line and second-line setting. Results. The series includes 11 single-arm trials and 18 randomized phase II or phase III trials with a total of 2903 patients. Treatment-naive patients or those in progression after first-line treatment were included in 16 and 13 trials, respectively. In 14 trials, only patients with non-squamous histology were eligible. Proportion of patients with nonsquamous carcinoma (in first-line setting), proportion of never-smokers (both in first- and second-line setting) and proportion of epidermal growth factor receptor (EGFR) mutant patients (both in first- and second-line setting) showed a moderate or strong correlation with median PFS. In six trials of intercalated treatment applied to treatment-naive EGFR%mutant patients, objective response was confirmed in 83.1% of cases and median PFS was 18.6 months. Conclusions. Most suitable candidates for intercalated treatment are treatment-naive patients with EGFR%mutant tumors, as determined from biopsy or liquid biopsy. For these patients, experience with intercalated treatment is most promising and randomized trials with comparison to the best standard treatment are warranted.

Keywords

lung cancer;NSCLC;intercalated treatment;EGFR;tyrosine -kinase inhibitors;

Data

Language:	English
Year of publishing:	2017
Typology:	1.01 - Original Scientific Article
Organization:	OI - Institute of Oncology
Publisher:	Association of Radiology and Oncology
UDC:	616-006
COBISS:	2780283
ISSN:	1318-2099
Parent publication:	Radiology and oncology
Views:	49
Downloads:	30
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Metadata:

Other data

Secondary language:	Slovenian
Secondary keywords:	pljučni rak;NSCLC;interkalacija;zdravljenje;EGFR;inhibitorji tirozin kinaz;
URN:	URN:NBN:SI
Type (COBISS):	Scientific work
Pages:	str. 241-251, I
Volume:	ǂVol. ǂ51
Issue:	ǂNo. ǂ3
Chronology:	Sep. 2017
DOI:	10.1515/raon-2017-0029
ID:	23914167