title: Tumor volume decrease at 8 weeks is associated with longer survival in EGFR-mutant advanced non-small-cell lung cancer patients treated with EGFR TKI.
abstract: BACKGROUND
  The study investigated whether tumor volume changes at 8 weeks of therapy is associated with outcomes in advanced non-small-cell lung cancer (NSCLC) patients harboring sensitizing epidermal growth factor receptor (EGFR) mutations treated with EGFR tyrosine kinase inhibitors (TKIs).
  
  
  METHODS
  In 56 advanced NSCLC patients with sensitizing EGFR mutations treated with first-line erlotinib or gefitinib, tumor volumes of dominant lung lesions were measured on baseline and follow-up computed tomography, and were analyzed for association with survival.
  
  
  RESULTS
  Among 56 eligible patients, the median tumor volume was 17.8 cm (range, 1.3-172.7 cm) on the baseline scans. Forty-nine patients had follow-up computed tomography at approximately 8 weeks; the median tumor volume at 8 weeks was 7.1 cm (range, 0.4-62.3 cm), with the median proportional volume change of -59% (range, -90% to +91%) from baseline. The proportional volume change at 8 weeks was associated with survival (p = 0.02). Using the cutoff value of 38% volume decrease (75th percentile) at 8 weeks, patients with volume decrease more than 38% (n = 37) had a median overall survival of 43.5 months compared with 16.3 months among those with volume decrease of 38% or less (n = 12; p = 0.01). The median progression-free survival for patients with more than 38% volume decrease was 12.6 months, compared with 5.5 months for those with 38% or lesser volume decrease (p = 0.2).
  
  
  CONCLUSIONS
  The proportional volume change at 8 weeks is associated with overall survival in EGFR-mutant advanced NSCLC patients treated with first-line EGFR-TKIs. The observation of the study, if confirmed in larger study cohorts, indicates that tumor volume analysis at 8 weeks may provide an early marker for survival, and contribute to therapeutic decision making by identifying patients who may benefit from additional anticancer therapy after 8 weeks of EGFR-TKI therapy.
authors.affiliation: Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA. Mizuki_Nishino@dfci.harvard.edu
authors.forename: Mizuki
authors.initials: M
authors.lastname: Nishino
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Dahlberg
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cardarella
authors.forename: David M
authors.initials: DM
authors.lastname: Jackman
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rabin
authors.forename: Hiroto
authors.initials: H
authors.lastname: Hatabu
authors.forename: Pasi A
authors.initials: PA
authors.lastname: Jänne
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000235:genetics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D047368:Tumor Burden
chemical_list: D047428:Protein Kinase Inhibitors; D066246:ErbB Receptors