title: Impact of Continuing First-Line EGFR Tyrosine Kinase Inhibitor Therapy Beyond RECIST Disease Progression in Patients with Advanced EGFR-Mutated Non-Small-Cell Lung Cancer (NSCLC): Retrospective GFPC 04-13 Study.
abstract: Retrospective studies suggested a benefit of first-line tyrosine kinase inhibitor (TKI) treatment continuation after response evaluation in solid tumors (RECIST) progression in epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) patients. The aim of this multicenter observational retrospective study was to assess the frequency of this practice and its impact on overall survival (OS). The analysis included advanced EGFR-mutated NSCLC patients treated with first-line TKI who experienced RECIST progression between June 2010 and July 2012. Among the 123 patients included (67 ± 12.7 years, women: 69 %, non smokers: 68 %, PS 0-1: 87 %), 40.6 % continued TKI therapy after RECIST progression. There was no difference between the patients who did and did not continue TKI therapy with respect to progression-free survival (PFS1: 10.5 versus 9.5 months, p = 0.4). Overall survival (OS) showed a non-significant trend in favor of continuing TKI therapy (33.0 vs. 21.2 months, p = 0.054). Progressions were significantly less symptomatic in the TKI continuation group than in the discontinuation group (18 % vs. 37 %, p < 0.01). Univariate analysis showed a higher risk of death among patients with PS >1 (HR 4.33, 95 %CI: 2.21-8.47, p = 0.001), >1 one metastatic site (HR 1.96, 95 %CI: 1.06-3.61, p = 0.02), brain metastasis (HR 1.75, 95 %CI: 1.08-2.84, p = 0.02) at diagnosis, and a trend towards a higher risk of death in cases of TKI discontinuation after progression (HR 1.62, 95 %CI: 0.98-2.67, p = 0.056 ). In multivariate analysis only PS >1 (HR 6.27, 95 %CI: 2.97-13.25, p = 0.00001) and >1 metastatic site (HR 2.54, 95 %CI: 1.24-5.21, p = 0.02) at diagnosis remained significant. This study suggests that under certain circumstances, first-line TKI treatment continuation after RECIST progression is an acceptable option in EGFR-mutated NSCLC patients.
  
  
  BACKGROUND
  NCT02293733.
authors: Service de Pneumologie et oncologie thoracique, Hôpital F Quesnay, 2 Boulevard de Sully, 78200, Mantes la Jolie, France. j-b.auliac@ch-mantes-la-jolie.fr.
authors: J B
authors: JB
authors: Auliac
authors: , Marseille, France.
authors: C
authors: C
authors: Fournier
authors: , Toulon, France.
authors: C
authors: C
authors: Audigier Valette
authors: , Lyon, France.
authors: M
authors: M
authors: Perol
authors: , La Roche Sur Yon, France.
authors: A
authors: A
authors: Bizieux
authors: , Creteil, France.
authors: F
authors: F
authors: Vinas
authors: , Prigny, France.
authors: C
authors: C
authors: Decroisette Phan van Ho
authors: , Rouen, France.
authors: S
authors: S
authors: Bota Ouchlif
authors: , Rennes, France.
authors: R
authors: R
authors: Corre
authors: , Saint Brieux, France.
authors: G
authors: G
authors: Le Garff
authors: , Saint-Priest En Jarez, France.
authors: P
authors: P
authors: Fournel
authors: , Angers, France.
authors: N
authors: N
authors: Baize
authors: , Lorient, France.
authors: R
authors: R
authors: Lamy
authors: , Limoges Cedex, France.
authors: A
authors: A
authors: Vergnenegre
authors: , Macon, France.
authors: D
authors: D
authors: Arpin
authors: , Limoges, France.
authors: B
authors: B
authors: Marin
authors: , Creteil, France.
authors: C
authors: C
authors: Chouaid
authors: , Caen, France.
authors: R
authors: R
authors: Gervais
mesh_terms: D000368:Aged; D001706:Biopsy; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000235:genetics; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D009154:Mutation; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D047428:Protein Kinase Inhibitors; C512478:EGFR protein, human; D066246:ErbB Receptors