SELECTION OF NON-SMALL CELL LUNG CANCER PATIENTS FOR INTERCALATED CHEMOTHERAPY AND TYROSINE KINASE INHIBITORS

  • Matjaz Zwitter Institute of Oncology Ljubljana
  • Antonio Rossi Division of Medical Oncology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
  • Massimo Di Maio Division of Medical Oncology, Mauriziano Hospital, Oncology Department, University of Turin, Torino, Italy
  • Maja Pohar Perme Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
  • Gilberto Lopes Centro Paulista de Oncologia e HCor Onco, members of the Oncoclínicas do Brasil Group, Sao Paulo, Brazil and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

Abstract

Background. When treating patients with advanced non-small cell lung cancer (NSCLC) with tyrosine kinase inhibitors and chemotherapy, intercalated schedule with time separation between the two classes of drugs should avoid their mutual antagonism. In a survey of published trials, we focus on relation between eligibility criteria and effectiveness of intercalated treatment.

Materials and Methods. Published documents were identified using major medical databases, conference proceedings and references of published trials. Median progression-free survival (PFS) was taken as the basic parameter of treatment efficacy. Correlation between characteristics of patients and median PFS was assessed through the Pearson’s correlation coefficient and the coefficient of determination, separately for first-line and second-line setting. 

Results. The series includes 11 single-arm trials and 18 randomized phase II or phase III trials with a total of 2903 patients. Treatment-naive patients or those in progression after first-line treatment were included in 16 and 13 trials, respectively. In 14 trials, only patients with non-squamous histology were eligible. Proportion of patients with non-squamous carcinoma (in first-line setting), proportion of never-smokers (both in first- and second-line setting) and proportion of epidermal growth factor receptor (EGFR) mutant patients (both in first- and second-line setting) showed a moderate or strong correlation with median PFS. In five trials of intercalated treatment applied to treatment-naive EGFR–mutant patients, median PFS was 18.6 months.

Conclusions. Most suitable candidates for intercalated treatment are treatment-naive patients with EGFR–mutant tumors, and possibly never-smokers with non-squamous histology and undetermined EGFR status. For these patients, experience with intercalated treatment is most promising and randomized trials with comparison to the best standard treatment are warranted.
Published
2017-09-10
How to Cite
Zwitter, M., Rossi, A., Di Maio, M., Pohar Perme, M., & Lopes, G. (2017). SELECTION OF NON-SMALL CELL LUNG CANCER PATIENTS FOR INTERCALATED CHEMOTHERAPY AND TYROSINE KINASE INHIBITORS. Radiology and Oncology, 51(3). Retrieved from https://radioloncol.com/index.php/ro/article/view/2816
Section
Clinical oncology