MD Conference Express - ELCC 2015 - (Page 18)
CLINICAL TRIAL HIGHLIGHTS
Platinum-Plus Regimens Equally
Effective First Therapies for
EGFR Wild-Type NSCLC
Written by Francesca Coltrera
This single-site, retrospective study compared the
efficacy of platinum doublet regimens used as firstline chemotherapy for patients with EGFR wild-type,
nonsquamous non-small cell lung cancer (NSCLC).
Investigators found no difference in survival, response
rate, and prognostic factors. Eun Joo Kang, MD, Korea
University Guro Hospital, Seoul, Korea, reported study
results in a poster presentation [Kang EJ et al. Ann
Oncol. 2015].
Molecular research and targeted agents like gefitinib
and erlotinib have improved outcomes for a subset of
NSCLC patients with EGFR mutations. Yet, platinum
doublet regimens remain first-line therapy for patients
with EGFR wild-type NSCLC, which accounts for more
than half of all NSCLC cases. In a randomized phase 3
study, overall survival (OS) was significantly better with
pemetrexed + cisplatin than a nonpemetrexed therapy
(gemcitabine + cisplatin) in a Western population composed of chemotherapy-naïve patients with adenocarcinoma (12.6 vs 10.9 months; P < .03) [Scagliotti GV et al.
J Clin Oncol. 2008].
Dr Kang and colleagues conducted a retrospective
analysis on 165 patients with EGFR wild-type nonsquamous NSCLC who had received first-line treatment
with pemetrexed + platinum (PP) or nonpemetrexed +
platinum (NPP) chemotherapy at Korea University
Guro Hospital between 2007 and 2013, analyzing
progression-free survival (PFS), OS, response rate, and
prognostic factors.
Almost all patients (91.5%) had adenocarcinoma.
Average age was 66 years and 71.5% were men. At diagnosis, 80.6% had stage IV disease. During treatment, 43%
had received PP and 57% had received NPP. In the NPP
group, patients had mainly received gemcitabine + carboplatin (37.2% of all NPP patients), paclitaxel + carboplatin
(19.1%), gemcitabine + cisplatin (18.1%), docetaxel +
cisplatin (11.8%), or paclitaxel + cisplatin (7.4%). Patient
characteristics were similar in the PP and NPP groups.
No difference between the 2 groups was reported in
median PFS (P = .12) or OS (P = .42), nor did OS differ
depending on which specific regimen was used (P = .82).
For patients who had received PP, median PFS and OS
were 4.6 months (95% CI, 3.8 to 5.4) and 18.7 months
(95% CI, 11.7 to 25.8), respectively. For patients who
had received NPP, median PFS and OS were 6.2 months
(95% CI, 3.4 to 5.0) and 12.2 months (95% CI, 10.3 to 14.1),
18
May 2015
respectively. There were no significant differences in
response rate, which was 26.8% in the PP group and
28.7% in the NPP group (P = .78).
During multivariate analysis looking at prognostic factors, prolonged OS was associated with a few
subgroups:
■ In PP patients:
{ Stages I-III at diagnosis
{ Metastasis restricted to lung, pleura, or both
{ Treatment > 2nd-line chemotherapy vs 1st-line only
■ In NPP patients:
{ Metastasis restricted to lung, pleura, or both
{ Treatment > 2nd-line chemotherapy vs 1st-line only
The data suggest no clear advantage in PFS, OS, or
response rate for patients with wild-type EGFR, nonsquamous NSCLC given PP or NPP as first-line therapy.
Although pemetrexed plus platinum has been regarded
as superior in nonsquamous NSCLC, this study did not
support that belief. Because the study was retrospective,
relatively small-scale, and conducted only on patients
from 1 hospital, further confirmation is needed.
SBRT as Effective Treatment
Option for Medically
Operable Stage I NSCLC
Written by Anita Misra-Press, PhD
A surgical lobectomy, or segmental, wedge, or sleeve
resection, is the primary treatment option for patients
with stage I (T1-2aN0M0) non-small cell lung cancer
(NSCLC) [National Cancer Institute. http://www.cancer.
gov/cancertopics/pdq/treatment/non-small-cell-lung/
healthprofessional/page7. Accessed April 22, 2014].
However, in patients with medically inoperable tumors,
stereotactic body radiation therapy (SBRT) is a safe and
effective treatment option conferring local control in
> 90% of patients [Timmerman R et al. JAMA. 2010]. An
international study of SBRT that reported high rates of
local control, low toxicities, and favorable overall survival (OS) in this patient population has led to a recent
increase in the number of patients with medically operable early stage NSCLC who prefer this treatment over
surgery [Grills IS et al. J Thorac Oncol. 2012].
Although no randomized trial comparing SBRT
with surgery has been reported to date, in an attempt
to indirectly address this question, Maddalena Rossi,
PhD, The Netherlands Cancer Institute, Amsterdam,
The Netherlands, and colleagues compared OS within
a large cohort of patients with medically operable stage
www.mdce.sagepub.com
http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional/page7
http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional/page7
http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional/page7
http://mdc.sagepub.com/
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Contents
MD Conference Express - ELCC 2015
MD Conference Express - ELCC 2015 - (Page Cover1)
MD Conference Express - ELCC 2015 - (Page Cover2)
MD Conference Express - ELCC 2015 - (Page i)
MD Conference Express - ELCC 2015 - (Page ii)
MD Conference Express - ELCC 2015 - Contents (Page 1)
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