Improved survival in patients with unresectable stage III EGFR-mutant adenocarcinoma with upfront EGFR-tyrosine kinase inhibitors

Sheng-Yuan Wang; Ching-Han Lai; Chian-Wei Chen; Szu-Chun Yang; Chao-Chun Chang; Chia-Ying Lin; Yi-Ting Yen; Yau-Lin Tseng; Po-Lan Su; Chien-Chung Lin; Wu-Chou Su

doi:10.1111/1759-7714.14237

Improved survival in patients with unresectable stage III EGFR-mutant adenocarcinoma with upfront EGFR-tyrosine kinase inhibitors

Thorac Cancer. 2022 Jan;13(2):182-189. doi: 10.1111/1759-7714.14237. Epub 2021 Nov 20.

Authors

Sheng-Yuan Wang¹, Ching-Han Lai¹, Chian-Wei Chen¹, Szu-Chun Yang¹, Chao-Chun Chang², Chia-Ying Lin³, Yi-Ting Yen², Yau-Lin Tseng², Po-Lan Su¹, Chien-Chung Lin^{1

4

5}, Wu-Chou Su^{4

6

7}

Affiliations

¹ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵ Institute of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁶ Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Center of Applied Nanomedicine, National Cheng Kung University, Tainan, Taiwan.

Abstract

Background: Although epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) have been the standard treatment for advanced EGFR-mutant adenocarcinoma, the effects of upfront EGFR-TKI use in unresectable stage III EGFR-mutant adenocarcinoma remain unexplored. Here, we conducted a retrospective study to compare different treatment strategies in these patients.

Methods: From October 2010 to June 2019, patients with unresectable stage III adenocarcinoma who received treatment at a tertiary referral center were enrolled. Patients were classified into three groups: EGFR-mutant adenocarcinoma treated with concurrent chemoradiotherapy (group 1) or EGFR-TKI (group 2) and EGFR wild-type adenocarcinoma treated with concurrent chemoradiotherapy (group 3). Progression-free survival, progression-free survival-2, and overall survival were estimated and compared using Kaplan-Meier and log-rank tests.

Results: A total of 92 patients were enrolled; 10, 40, and 42 patients were assigned to groups 1, 2, and 3, respectively. Patients with EGFR mutations who received upfront EGFR-TKIs had significantly longer progression-free and overall survival than those who received upfront concurrent chemoradiotherapy (hazard ratio 0.33 vs. 0.34, p = 0.006 vs. 0.031) according to a Cox model adjusted for possible confounders. Moreover, upfront concurrent chemoradiotherapy did not lead to higher survival rates in patients with EGFR mutations than in those with EGFR wild-type adenocarcinoma (progression-free survival; hazard ratio 0.37, p = 0.036; overall survival; hazard ratio 0.35, p = 0.080) by Cox regression analysis.

Conclusion: This current study suggests that EGFR-TKIs is a better choice for patients with unresectable stage III EGFR-mutant adenocarcinoma. However, further randomized studies are required to validate the results.

Keywords: adenocarcinoma; chemoradiotherapy; epidermal growth factor receptor; stage III; tyrosine kinase inhibitors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma of Lung / mortality*
Adenocarcinoma of Lung / therapy*
Aged
Chemoradiotherapy / methods
ErbB Receptors / genetics
Female
Humans
Lung Neoplasms / mortality*
Lung Neoplasms / therapy*
Male
Middle Aged
Mutation
Progression-Free Survival
Protein Kinase Inhibitors / pharmacology*
Retrospective Studies

Substances

Protein Kinase Inhibitors
EGFR protein, human
ErbB Receptors