Background The efficacy of chemotherapy has reached a plateau for advanced non-small cell lung cancer (NSCLC). Increasing evidence has demonstrated that patients with sensitising mutations in the epidermal growth factor receptor (EGFR) are associated with sensitivity to reversible EGFR tyrosine kinase inhibitors (TKIs). Numerous studies have demonstrated improvement of progression-free survival compared to conventional chemotherapy as first-line treatment for advanced NSCLC with EGFR mutations.
Purpose To evaluate mortality and overall survival (OS) in NSCLC patients treated with EGFR-TKIs or chemotherapy according to their EGFR status.
Materials and Methods Retrospective study. Sixty-one patients diagnosed with NSCLC and available EGFR status during 2008–2012 were included. Socio-demographic, clinical and pharmacological characteristics of patients were collected. Comparison of medians by Mann-Whitney-Wilcoxon Test for numerical variables and Chi-Square Test for categorical variables was performed.
Results Mean age was 62 ± 12years; 52.5% (32/61) male; 70.5% (43/61) smokers/ex-smokers; 60.7% (37/61) stage IV; 42.6% (23/54) mutant EGFR. Minimum follow-up of 6 months was accomplished in 54 patients.
An EGFR-TKI was prescribed as first-line treatment in 65.2% (15/23) EGFR-positive patients, 80.0% (12/15) stage IV, with an OS of 12.40[11.30–23.33] months and 53.3% (8/15) deaths. Two patients required second-line chemotherapy (2/15; 13.3%).
Chemotherapy as first-line treatment was prescribed in 75% patients (46/61), 17% EGFR-positive (8/46), 50.0% (4/8) stage IV, with 29% (2/7) deaths. EGFR-TKIs were used as second-line treatment in 87.5% (7/8) patients and third-line in 12.5% (1/8). OS was 17.97[8.83–60.84] months.
EGFR was native in 67.4% (31/46) patients, 58.1% (18/31) stage IV, and 61.3% (19/31) deaths. EGFR-TKIs as second-line treatment were prescribed in 61.3%. (19/31) patients, third-line in 35.5% (11/31) and fourth-line in 3.2% (1/31).
Seven patients had unknown EGFR status (7/61; 11.5%), 57.1% (4/7) stage IV, and 42.8% (3/7) deaths. EGFR-TKI as second-line treatment was prescribed in 85.7% (6/7) patients and fourth-line treatment in 14.3% (1/7).
OS and mortality were not statistically different between EGFR-positive patients treated with EGFR-TKIs/chemotherapy as first-line treatment (P = 0.836; p = 0.105). Mortality was not associated with stage or EGFR status (P = 0.086; p = 1.000).
Conclusions Mortality and OS are not associated with EGFR status or stage in this NSCLC population. EGFR-positive patients present similar OS and mortality rates regardless of first-line treatment.
No conflict of interest.
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