Randomized phase II study of concurrent versus sequential alternating gefitinib and chemotherapy in previously untreated non-small cell lung cancer with sensitive EGFR mutations: NEJ005/TCOG0902

被引:95
作者
Sugawara, S. [1 ]
Oizumi, S. [2 ]
Minato, K. [3 ]
Harada, T. [4 ]
Inoue, A. [5 ]
Fujita, Y. [6 ]
Maemondo, M. [7 ]
Yoshizawa, H. [8 ]
Ito, K. [9 ]
Gemma, A. [10 ]
Nishitsuji, M. [11 ]
Harada, M. [12 ]
Isobe, H. [13 ]
Kinoshita, I. [14 ]
Morita, S. [15 ]
Kobayashi, K. [16 ]
Hagiwara, K. [17 ]
Kurihara, M. [18 ]
Nukiwa, T. [19 ]
机构
[1] Sendai Kousei Hosp, Dept Pulm Med, Sendai, Miyagi, Japan
[2] Hokkaido Univ, Sch Med, Dept Med 1, Sapporo, Hokkaido 0608638, Japan
[3] Gunma Prefectural Canc Ctr, Dept Resp Med, Gunma, Japan
[4] JCHO Hokkaido Hosp, Ctr Resp Dis, Sapporo, Hokkaido, Japan
[5] Tohoku Univ Hosp, Dept Resp Med, Sendai, Miyagi, Japan
[6] Asahikawa Med Ctr, Dept Resp Med, Natl Hosp Org, Asahikawa, Hokkaido, Japan
[7] Miyagi Canc Ctr, Dept Resp Med, Natori, Miyagi 9811293, Japan
[8] Niigata Univ, Biosci Med Res Ctr, Med & Dent Hosp, Niigata, Japan
[9] Niigata City Gen Hosp, Dept Resp Med, Niigata, Japan
[10] Nippon Med Sch, Grad Sch Med, Dept Pulm Med & Oncol, Tokyo 113, Japan
[11] Ishikawa Prefectural Cent Hosp, Dept Resp Med, Kanazawa, Ishikawa, Japan
[12] Hokkaido Canc Ctr, Natl Hosp Org, Dept Resp Med, Sapporo, Hokkaido, Japan
[13] KKR Sapporo Med Ctr, Dept Med Oncol, Sapporo, Hokkaido, Japan
[14] Hokkaido Univ, Dept Med Oncol, Grad Sch Med, Sapporo, Hokkaido, Japan
[15] Kyoto Univ, Grad Sch Med, Dept Biomed Stat & Bioinformat, Kyoto, Japan
[16] Saitama Med Univ, Int Med Ctr, Dept Resp Med, Hidaka, Japan
[17] Saitama Med Univ, Dept Resp Med, Saitama, Japan
[18] Tokyo Cooperat Oncol Grp, Tokyo, Japan
[19] Japan AntiTB Assoc, Tokyo, Japan
关键词
non-small cell lung cancer; first-line; EGFR-TKI; chemotherapy; combination; EGFR mutation; OPEN-LABEL; CARBOPLATIN-PACLITAXEL; MAINTENANCE THERAPY; 1ST-LINE TREATMENT; JAPANESE PATIENTS; DOUBLE-BLIND; ERLOTINIB; COMBINATION; CISPLATIN; TRIAL;
D O I
10.1093/annonc/mdv063
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The first-line combination of an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) and platinum-based doublet chemotherapy has not been sufficiently evaluated for patients with EGFR-mutant non-small cell lung cancer (NSCLC). This randomized phase II study was designed to select a combination regimen for phase III evaluation. Patients and methods: Chemotherapy-naive patients with advanced non-squamous, EGFR-mutant NSCLC were randomly assigned to receive either a concurrent or a sequential alternating regimen with gefitinib (250 mg) and carboplatin/pemetrexed [area under the curve (AUC) = 6 and 500 mg/m(2); 3-weekly]. The primary end point was progression-free survival (PFS). Secondary end points were overall survival (OS), response, and safety. Results: All 80 patients enrolled were eligible and assessable for efficacy (41 and 39 patients in the concurrent and sequential alternating regimen groups, respectively). Median PFS was 18.3 months for the concurrent regimen and 15.3 months for the sequential alternating regimen [hazard ratio (HR) 0.71 (0.42-1.20), P = 0.20]. Although OS data are immature (16 and 24 death events), median survival times were 41.9 and 30.7 months in the concurrent and sequential alternating regimen groups, respectively [HR 0.51 (0.26-0.99); P = 0.042]. Response rates were similar in both groups (87.8% and 84.6%). Hematological and non-hematological adverse events were common and reversible; interstitial lung disease was neither frequent nor fatal (two cases in each group; 5% of all patients). Conclusion: This is the first randomized study to investigate the efficacy of combinational EGFR-TKI and chemotherapy in the EGFR-mutated setting. Both regimens had promising efficacy with predictable toxicities, although concurrent regimens might provide better OS. The concurrent regimen was chosen to compare with gefitinib monotherapy in our ongoing phase III study.
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页码:888 / 894
页数:7
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