Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Thorac Oncol. 2014 Apr;9(4):506-11. doi: 10.1097/JTO.0000000000000095.
Gefitinib and erlotinib, small-molecule kinase inhibitors that block epidermal growth factor receptor (EGFR) signaling, have demonstrated a dramatic response rate and prolonged progression-free survival (PFS) in patients harboring an activating EGFR mutation. We compared the clinical outcomes in gefitinib- and erlotinib-treated patients harboring EGFR mutations who had recurrent or metastatic non-small-cell lung cancer (NSCLC).
A total of 375 patients with recurrent or metastatic stage IIIB/IV NSCLC, who had either exon 19 deletion or the L858R mutation in exon 21, and had received either gefitinib (n = 228) or erlotinib (n = 147), were included in the study. A matched-pair case-control study design was implemented in the analysis, where 121 pairs of gefitinib-treated and erlotinib-treated patients were matched according to sex, smoking history, Eastern Cooperative Oncology Group performance status, and types of EGFR mutation.
The median age of all patients was 58 years (range, 30-84), and more than half of patients had never been smokers (63.6%). Most patients had adenocarcinoma (98.3%) and good Eastern Cooperative Oncology Group performance status (0, 1) (90.9%). The median number of cycles of EGFR tyrosine kinase inhibitor (TKI) treatment was 12.7 in the gefitinib group and 10.8 in the erlotinib group. Of the 242 patients, 63 (26%) received EGFR TKI as first-line therapy. The overall response rates and disease control rates in the gefitinib- or erlotinib-treated groups were 76.9% versus 74.4% (p = 0.575) and 90.1% versus 86.8%, respectively (p = 0.305). There was no statistically significant difference with regard to PFS (median, 11.7 versus 9.6; p = 0.056) between the gefitinib- and erlotinib-treated groups. For patients receiving EGFR TKI as the first-line treatment, there was no significant difference between the two treatment groups in overall response rates (76.7% and 90.0%) (p = 0.431) and median PFS (11.7 versus 14.5 months) (p = 0.507).
In NSCLC patients harboring EGFR mutation, treatment with gefitinib and erlotinib resulted in similar effectiveness.
吉非替尼和厄洛替尼是两种小分子激酶抑制剂，可阻断表皮生长因子受体（EGFR）信号通路，在携带激活型 EGFR 突变的患者中显示出显著的缓解率和延长的无进展生存期（PFS）。我们比较了患有复发性或转移性非小细胞肺癌（NSCLC）并携带 EGFR 突变的接受吉非替尼和厄洛替尼治疗的患者的临床结局。
共纳入 375 例患有复发性或转移性 IIIB/IV 期 NSCLC、携带外显子 19 缺失或外显子 21 的 L858R 突变、接受吉非替尼（n = 228）或厄洛替尼（n = 147）治疗的患者。采用配对病例对照研究设计进行分析，根据性别、吸烟史、东部肿瘤协作组（ECOG）体能状态和 EGFR 突变类型，对 121 对吉非替尼治疗和厄洛替尼治疗的患者进行匹配。
所有患者的中位年龄为 58 岁（范围，30-84 岁），超过一半的患者从不吸烟（63.6%）。大多数患者为腺癌（98.3%），ECOG 体能状态良好（0，1）（90.9%）。吉非替尼组和厄洛替尼组 EGFR 酪氨酸激酶抑制剂（TKI）治疗的中位周期数分别为 12.7 个和 10.8 个。在 242 例患者中，63 例（26%）接受 EGFR TKI 作为一线治疗。吉非替尼或厄洛替尼治疗组的总缓解率和疾病控制率分别为 76.9%比 74.4%（p = 0.575）和 90.1%比 86.8%（p = 0.305）。两组间 PFS 无统计学差异（中位值，11.7 比 9.6；p = 0.056）。对于接受 EGFR TKI 作为一线治疗的患者，两组在总缓解率（76.7%和 90.0%）（p = 0.431）和中位 PFS（11.7 比 14.5 个月）（p = 0.507）方面无显著差异。
在携带 EGFR 突变的 NSCLC 患者中，吉非替尼和厄洛替尼的治疗效果相似。
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