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Yao-Wen Kuo

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    P2.13 - Targeted Therapy (Not CME Accredited Session) (ID 962)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.13-20 - The Comparative Effectiveness of Gefitinib Versus Erlotinib on the Intracranial Progression-Free Survival in Patients with Brain Metastasis (ID 11173)

      16:45 - 18:00  |  Presenting Author(s): Yao-Wen Kuo

      • Abstract
      • Slides


      The high peak plasma concentrations and better blood-brain barrier permeability of erlotinib compared with gefitinib was reported. However, there were few researches comparing their treatment effect for brain metastasis. This study aimed to investigate the comparative effectiveness of gefitinib versus erlotinib on the survival in patients with brain metastasis from lung adenocarcinoma.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Incident lung adenocarcinoma patients at National Taiwan University Hospital between Jan 2013 and May 2015 were reviewed and analyzed. The inclusion criteria were: (1) tumor harboring either EGFR exon 19 deletion or L858R mutation (2) patient taking gefitinib or erlotinib as their first-line treatment (3) patients with brain metastasis. Kaplan-Meier analyses with long-rank testing were used to estimate the intracranial progression-free survival (PFS) and overall survival between the gefitinib and erlotinib group. A Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95% confidence intervals (CI) for age, gender, gefitinib vs. erlotinib, Eastern Cooperative Oncology Group performance status(ECOG), and pre-treatment for brain metastasis. Cumulative incidence of intracranial progression using competing risks regression model was also conducted.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 84 patients were included; 61 patients were female. 37 patients harbored EGFR exon 19 deletion. 39 patients received erlotinib as their first-line treatment.73 patients had Eastern Cooperative Oncology Group performance status scores of 0-1. 48 patients had multiple brain metastases (number >5) and 14 patients had brain metastasis ≥ 3 cm in size. 25 patients received whole brain radiation therapy and 7 patients received stereotactic radiosurgery before taking the tyrosine kinase inhibitors.

      The median overall survival for the gefitinib group and the erlotinib group was 874 vs. 750 days (p=0.86, Fig 1), and the median intracranial PFS 652 vs. 833 days (p=0.38, Fig 2). Multivariable analysis indicated that erlotinib was associated with a better intracranial PFS. (HR: 0.34, 95% CI: 0.12-0.97). The competing risks regression model showed erlotinib was associated with a trend toward lower probability of intracranial progression, with adjusted subdistribution hazard ratio of 0.40 (95% CI, 0.16-1.03; p=0.06, Fig 3).

      8eea62084ca7e541d918e823422bd82e Conclusion

      In patients with brain metastasis from lung adenocarcinoma, this study showed the beneficial effectiveness of erlotinib on the intracranial progression-free survival compared with gefitinib.


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