Postoperative recurrent disease affects NSCLC survival after gefitinib

By Nikki Withers, medwireNews Reporter

Patients with postoperative recurrent non-small-cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations have longer progression-free (PFS) and overall survival (OS) with gefitinib treatment, than those with stage IV disease, Japanese researchers report.

“These results suggest that postoperative recurrent disease may be considered a stratification factor in clinical trials for NSCLC with EGFR mutations”, writes the team.

The study was based on data from 168 patients who were treated with the oral EGFR–tyrosine kinase inhibitor (TKI) gefitinib, at the Shizuoka Cancer Center between September 2002 and March 2012. Of these, 49 had stage I to IV postoperative recurrent NSCLC and 119 had stage IV NSCLC at diagnosis. The median follow-up period was 24.6 months.

As reported in the International Journal of Clinical Oncology, the response rate of gefitinib treatment in the postoperative group was comparable to that of the stage IV group (58 vs 61%).

Median PFS and OS, however, were significantly longer in the postoperative group, at 15.8 versus 9.8 months and 51.1 versus 22.2 months, respectively.

Multivariate analysis revealed that postoperative recurrent disease (hazard ratio [HR]=0.39), performance status (0–1; HR=0.46), and a single metastatic organ (HR=0.44) were all associated with a significantly improved chance of survival.

Previous studies have suggested that differences in tumour heterogeneity and burden may be associated with favourable progression free and overall survival in patients with postoperative recurrent NSCLC. Indeed, in the present study patients in the postoperative group had fewer metastatic sites than those in the stage IV group.

“These results suggest that surgical reduction of tumor burden may improve the effectiveness of gefitinib treatment in patients with stage IV NSCLC harboring EGFR mutations”, say Hirotsugu Kenmotsu (Shizuoka Cancer Center) et al.

The team notes that surgery is used to reduce tumour burden for some malignancies including ovarian and kidney tumours.“Therefore, further clinical trials are warranted to develop and evaluate new treatment methods for patients with stage IV NSCLC harboring EGFR mutations”, they say.

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