A review of treatments for non-small cell lung cancer (NSCLC) that is epidermal growth factor receptor mutation positive (EGFR M+) has identified which therapies are the most effective at managing disease symptoms and progression.
For the review, Researchers led by Janette Greenhalgh, PhD, PGCE, University of Liverpool (London, UK), conducted a comprehensive search of published literature, including abstracts from recent American Society for Clinical Oncology and European Society for Medical Oncology annual meetings. The primary outcome measure was overall survival, but they also looked at how different drugs affected progression-free survival, response rate, toxicity, and quality of life. They published their findings in the Cochrane Database of Systematic Reviews.
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A total of 19 studies were identified for review, 7 of which dealt exclusively with patients with EGFR+ NSCLC. The remaining 12 trials included results for these patients as part of a subgroup analysis. In all, researchers were able to identify a total of 2317 patients with the EGFR M+ NSCLC. These patients were treated with four different drugs: erlotinib (8 trials), gefitinib (7 trials), afatinib (2 trials), and cetuximab (2 trials).
In one trial, erlotinib plus cytotoxic chemotherapy showed statistically significant improvement in overall survival compared with cytotoxic chemotherapy alone, though the study population was relatively small (N=97). However, a pooled analysis of 3 trials found that progression-free survival was significantly longer in patients who had erlotinib added to cytotoxic chemotherapy compared with those who received cytotoxic chemotherapy alone.
Gefitinib and afatinib also demonstrated superior progression-free survival compared with chemotherapy, the former in a pooled analysis of two trials with 491 patients and the latter in data taken from two other trials with 709 patients.
There was no significant improvement in progression-free survival or overall survival among patients who received cetuximab plus cytotoxic chemotherapy compared with chemotherapy alone in two pooled trials with 81 patients.
Additionally, in six trials reporting on the quality of life and symptom management associated with the use of erlotinib, gefitinib, and afatinib, each drug showed improvement in one or more metrics versus chemotherapy.
“Erlotinib, gefitinib, and afatinib are all active agents in EGFR M+ NSCLC patients, and demonstrate an increased tumour response rate and prolonged progression-free survival compared to cytotoxic chemotherapy,” the authors concluded.
