Clinical management and outcome of patients with advanced NSCLC carrying EGFR mutations in Spain
Por:
Arriola E, Garcia Gomez R, Diz P, Majem M, Martinez Aguillo M, Valdivia J, Paredes A, Sanchez-Torres JM, Peralta Muñoz S, Barneto I, Gutierrez V, Andrade Santiago JM, Aparisi F, Isla D, Ponce S, Vicente Baz D, Artal A, Amador M and Provencio M
Publicada:
30 ene 2018
Ahead of Print:
30 ene 2018
Resumen:
Background: Although the benefit of first-line epidermal growth factor
receptor (EGFR) tyrosine-kinase inhibitors (TKIs) over chemotherapy has
been demonstrated in several clinical trials, data from clinical
practice is lacking and the optimal EGFR TKI to be used remains unclear.
This study aims to assess the real-life diagnostic and clinical
management and outcome of patients with advanced non-small-cell lung
cancer (NSCLC) carrying EGFR mutations in Spain.
Methods: All consecutive patients recently diagnosed with advanced or
metastatic NSCLC from April 2010 to December 2011 in 18 Spanish
hospitals and carrying EGFR mutations were retrospectively evaluated.
Results: Between March and November 2013, a total of 187 patients were
enrolled (98.3% Caucasian, 61.9% female, 54.9% never-smokers, 89.0%
adenocarcinoma). Mutation testing was mainly performed on biopsy tumour
tissue specimens (69.0%) using a qPCR-based test (90%) (47.0%
Therascreen EGFR PCR Kit). Common sensitising mutations were detected in
79.8% of patients: 57.1% had exon 19 deletions and 22.6% exon 21 L858R
point mutations. The vast majority of patients received first-line
therapy (n = 168; 92.8%). EGFR TKIs were the most commonly used
first-line treatment (81.5%), while chemotherapy was more frequently
administered as a second-and third-line option (51.9% and 56.0%,
respectively). Of 141 patients who experienced disease progression, 79
(56.0%) received second-line treatment. After disease progression on
first-line TKIs (n = 112), 33.9% received chemotherapy, 8.9%
chemotherapy and a TKI, and 9.8% continued TKI therapy. Most patients
received first-line gefitinib (83.0%), while erlotinib was more
frequently used in the second-line setting (83.0%). Progression-free
survival (PFS) and overall survival (OS) in patients harbouring common
mutations were 11.1 months and 20.1 months respectively (exon 19
deletions: 12.4 and 21.4 months; L858R: 8.3 and 14.5 months), and 3.9
months and 11.1 months respectively for those with rare mutations.
Conclusion: EGFR TKIs (gefitinib and erlotinib) are used as the
preferred first-line treatment while chemotherapy is more frequently
administered as a second-and third-line option in routine clinical
practice in Spain. In addition, efficacy data obtained in the real-life
setting seem to concur with data from EGFR TKI phase III pivotal studies
in NSCLC.
Filiaciones:
Arriola E:
Medical Oncology Department, Hospital del Mar, Passeig Marítim, 25-29, 08018, Barcelona, Spain.
Garcia Gomez R:
Hospital General Universitario Gregorio Marañón, Madrid, Spain
Hospital General Universitario Gregorio Maranon, Madrid, Spain
Diz P:
Hospital Universitario de León, León, Spain
Majem M:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Martinez Aguillo M:
Complejo Hospitalario de Navarra, Pamplona, Spain
Valdivia J:
Hospital Universitario Virgen de las Nieves, Granada, Spain
Paredes A:
Hospital Universitario Donostia, San Sebastián, Spain
Sanchez-Torres JM:
Hospital Universitario de La Princesa, Madrid, Spain
Peralta Muñoz S:
Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
Barneto I:
Hospital Universitario Reina Sofía, Córdoba, Spain
Gutierrez V:
Hospital Regional Universitario Carlos Haya, Málaga, Spain
Andrade Santiago JM:
Hospital Virgen de la Salud, Toledo, Spain
:
Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
Isla D:
Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
Ponce S:
Hospital Universitario 12 de Octubre, Madrid, Spain
Vicente Baz D:
Hospital Universitario Virgen Macarena, Sevilla, Spain
Artal A:
Hospital Universitario Miguel Servet, Zaragoza, Spain
Amador M:
AstraZeneca, Madrid, Spain
Provencio M:
Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
Open Access
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