Abstract
Introduction
Although most NSCLC patients with sensitizing epidermal growth factor receptor (EGFR) mutations have an impressive initial response, the vast majority has residual disease
and develops acquired resistance after 9 to 14 months of EGFR tyrosine kinase (TKI)
therapy. We recently reported a phase II trial showing that, for patients with molecularly
unselected oligometastatic NSCLC who did not progress after first-line systemic therapy,
local consolidation therapy (LCT) with surgery or radiation improved progression-free
survival (PFS), compared with maintenance therapy alone. Herein, we report a retrospective
analysis of LCT after TKI in patients with metastatic EGFR mutant NSCLC.
Patients and Methods
We identified patients with metastatic EGFR mutant NSCLC treated with TKI plus LCT or with TKI alone in the MD Anderson GEMINI
(Genomic Marker-Guided Therapy Initiative) database and in our recently published
LCT trial. PFS was compared between LCT plus TKI and TKI only treated patients using
the log-rank test.
Results
We identified 129 patients with EGFR mutant NSCLC who were treated with first-line TKI and 12 that were treated with TKI
followed by LCT. Among the 12 patients treated with TKI plus LCT, 8 patients had oligometastatic
disease (defined as ≤ 3 metastases), and 4 patients had > 3 metastases. LCT regimens
were hypofractionated radiotherapy or stereotactic ablative body radiotherapy for
11 patients and surgery for 1 patient. TKI followed by LCT resulted in a significantly
longer PFS (36 months) compared with TKI alone (PFS, 14 months; log-rank P = .0024).
Conclusions
Our data suggests that first-line TKI plus LCT is a promising therapeutic strategy
for patients with EGFR mutant NSCLC that merits further investigation.
Keywords
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Article Info
Publication History
Published online: September 24, 2018
Accepted:
September 18,
2018
Received in revised form:
September 11,
2018
Received:
June 13,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
