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Gefitinib Versus Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR -Mutated Lung Cancer.

Research paper by Vanita V Noronha, Vijay Maruti VM Patil, Amit A Joshi, Nandini N Menon, Anuradha A Chougule, Abhishek A Mahajan, Amit A Janu, Nilendu N Purandare, Rajiv R Kumar, Sucheta S More, Supriya S Goud, Nandkumar N Kadam, Nilesh N Daware, Atanu A Bhattacharjee, Srushti S Shah, et al.

Indexed on: 21 Aug '20Published on: 15 Aug '19Published in: Journal of clinical oncology : official journal of the American Society of Clinical Oncology



Abstract

Standard first-line therapy for -mutant advanced non-small-cell lung cancer (NSCLC) is an epidermal growth factor receptor (EGFR)-directed oral tyrosine kinase inhibitor. Adding pemetrexed and carboplatin chemotherapy to an oral tyrosine kinase inhibitor may improve outcomes. This was a phase III randomized trial in patients with advanced NSCLC harboring an -sensitizing mutation and a performance status of 0 to 2 who were planned to receive first-line palliative therapy. Random assignment was 1:1 to gefitinib 250 mg orally per day (Gef) or gefitinib 250 mg orally per day plus pemetrexed 500 mg/m and carboplatin area under curve 5 intravenously every 3 weeks for four cycles, followed by maintenance pemetrexed (gefitinib plus chemotherapy [Gef+C]). The primary end point was progression-free survival (PFS); secondary end points included overall survival (OS), response rate, and toxicity. Between 2016 and 2018, 350 patients were randomly assigned to Gef (n = 176) and Gef+C (n = 174). Twenty-one percent of patients had a performance status of 2, and 18% of patients had brain metastases. Median follow-up time was 17 months (range, 7 to 30 months). Radiologic response rates were 75% and 63% in the Gef+C and Gef arms, respectively ( = .01). Estimated median PFS was significantly longer with Gef+C than Gef (16 months [95% CI, 13.5 to 18.5 months] 8 months [95% CI, 7.0 to 9.0 months], respectively; hazard ratio for disease progression or death, 0.51 [95% CI, 0.39 to 0.66]; < .001). Estimated median OS was significantly longer with Gef+C than Gef (not reached 17 months [95% CI, 13.5 to 20.5 months]; hazard ratio for death, 0.45 [95% CI, 0.31 to 0.65]; < .001). Clinically relevant grade 3 or greater toxicities occurred in 51% and 25% of patients in the Gef+C and Gef arms, respectively ( < .001). Adding pemetrexed and carboplatin chemotherapy to gefitinib significantly prolonged PFS and OS but increased toxicity in patients with NSCLC.

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