Clinical management and outcome of patients with advanced NSCLC carrying EGFR mutations in Spain
Por:
Arriola, E, Gomez, RG, Diz, P, Majem, M, Aguillo, MM, Valdivia, J, Paredes, A, Sanchez-Torres, JM, Munoz, SP, Barneto, I, Gutierrez, V, Santiago, JMA, Aparisi, F, Isla, D, Ponce, S, Baz, DV, Artal, A, Amador, M, Provencio, M
Publicada:
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:
Hosp Mar, Med Oncol Dept, Passeig Maritim,25-29, Barcelona 08018, Spain
Gomez, RG:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Diz, P:
Hosp Univ Leon, Leon, Spain
Majem, M:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Aguillo, MM:
Complejo Hosp Navarra, Pamplona, Spain
Valdivia, J:
Hosp Univ Virgen Nieves, Granada, Spain
Paredes, A:
Hosp Univ Donostia, San Sebastian, Spain
Sanchez-Torres, JM:
Hosp Univ La Princesa, Madrid, Spain
Munoz, SP:
Hosp Univ St Joan de Reus, Tarragona, Spain
Barneto, I:
Hosp Univ Reina Sofia, Cordoba, Spain
Gutierrez, V:
Hosp Reg Univ Carlos Haya, Malaga, Spain
Santiago, JMA:
Hosp Virgen Salud, Toledo, Spain
Aparisi, F:
Hosp Virgen Lirios, Alicante, Spain
Isla, D:
Hosp Clin Univ Lozano Blesa, Zaragoza, Spain
Ponce, S:
Hosp Univ 12 Octubre, Madrid, Spain
Baz, DV:
Hosp Univ Virgen Macarena, Seville, Spain
Artal, A:
Hosp Univ Miguel Servet, Zaragoza, Spain
Amador, M:
AstraZeneca, Madrid, Spain
Provencio, M:
Hosp Univ Puerta Hierro Majadahonda, Madrid, Spain
Gold, Green Published
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