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Revisiting Chemo in EGFR-Mutant NSCLC

*December 2019*

Adding chemotherapy to a targeted agent doubled progression-free survival (PFS) for patients with advanced EGFRmutant non-small cell lung cancer (NSCLC), according to two randomized trials.

phase III trial from India showed that median PFS increased from 8 months with the EGFR inhibitor gefitinib (Iressa) to 16 months with gefitinib plus chemotherapy. A randomized phase II study from Japan yielded a median PFS of 20.9 months with chemotherapy plus gefitinib and 11.9 months with gefitinib alone. Both trials showed significant improvement in overall survival (OS) and objective response rate.

Grade ≥3 toxicity occurred significantly more often with chemotherapy, investigators reported in separate articles in the Journal of Clinical Oncology.

The studies used a first-generation EGFR inhibitor, which begs the question of how the results might have turned out with the third-generation EGFR inhibitor osimertinib (Tagrisso), authors of an accompanying editorial observed. Even so, the results have practice-changing implications for some patients with advanced EGFR-mutant NSCLC

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