Author of

• 36336

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  P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Targeted Therapy - Clinically Focused
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 36431

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    P76.77 - Combination of EGFR-TKIs with Chemotherapy versus EGFR-TKIs alone in EGFR-Mutant Advanced NSCLC with Concomitant Genetic Alterations (ID 3442)

    00:00 - 00:00  |  Presenting Author(s): Weineng Feng
    • Abstract
    • Slides

    Introduction
    

    Non-small-cell lung cancer (NSCLC) patients with both epidermal growth factor receptor (EGFR) mutation and specific concomitant genomic alterations, such as MLH1 V384D polymorphism, TP53, KRAS and PIK3CA mutations, had an impaired clinical response to EGFR-tyrosine kinase inhibitors (TKIs). The current study aimed to investigate the clinical efficacy of EGFR-TKIs plus chemotherapy versus EGFR-TKIs alone as first-line treatment in EGFR-mutant advanced NSCLC with or without concomitant genetic alterations (ChiCTR1800016672).

    Methods
    

    According to the next generation sequencing result on baseline, patients with EGFR sensitive mutations were enrolled and distinguished into cases with concomitant alterations (MLH1 V384D/TP53/KRAS/PIK3CA), and without concomitant alterations. These two cohorts were further randomly assigned 1:1 to receive EGFR-TKI plus pemetrexed (500mg/m2, day1, Q21) or EGFR-TKI alone. EGFR-TKI can be selected as one of gefitinib, erlotinib and icotinib. Treatment was continued until occurrence of disease progression or intolerable toxic effects. The primary endpoint was progression-free survival (PFS).

    Results
    

    Up to June 2020, a total of 82 patients (median age, 65 [38-82] years; 68.3% female) with NSCLC were enrolled in this study. Concomitant alterations were detected in 29.3% (24/82) of the patients. In the concomitant alterations cohort, EGFR-TKIs plus pemetrexed showed significant improvement in PFS compared with EGFR-TKIs alone (median PFS: 15.8 vs. 5.0 months, P=0.035). On the contrary, EGFR-TKIs plus pemetrexed did not improve PFS in the non-concomitant alterations cohort (median PFS: 12.2 vs. 11.1 months, p=0.988).

    Conclusion
    

    In sensitive EGFR-mutant NSCLC, the addition of pemetrexed to EGFR-TKIs results in significantly prolonged PFS in patients with concomitant alterations in MLH1 V384D, TP53, KRAS or PIK3CA, but not in patients without theses concomitant alterations.

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