Upfront gefitinib/erlotinib treatment followed by concomitant radiotherapy for advanced lung cancer: a mono-institutional experience.

Abstract

BACKGROUND:

Upfront tyrosine kinase inhibitor (TKI) has proved effective for selective advanced lung cancer patients in Taiwan. We hypothesized that early integration of radiotherapy during TKI treatment would decrease the chance of drug resistance and prolong progression-free survival (PFS).

METHODS:

This study included 25 patients with stage IIIb or IV non-squamous cell, non-small cell lung cancer (NSqCLC) who responded to upfront TKI treatment. Multi-target radiotherapy was administered during the TKI treatment course. Tomotherapy comprising a hypofractionated schedule with a dose of 40-50 Gy in 16-20 fractions was used for individual metastatic lesions.

RESULTS:

The patients' median follow-up duration was 30 months (range, 9-62 months). Of the 23 patients who had stage IV disease, 9 had oligometastases (≤5 gross target volumes) and 14 were in the more advanced stages of the disease. Twelve patients received more than 1 cycle of radiotherapy (median, 3; range, 2-6) with TKI being the only systemic treatment before they were salvaged with chemotherapy. The overall response rate after radiotherapy was 84.0%, and the median PFS was 16 months. The 3-year overall survival rate was 62.5% (95% confidence interval [CI], 39.1-85.8%). Toxicities were generally tolerated but it is necessary to prevent radiation-induced pneumonitis.

CONCLUSION:

We showed that combined first-line TKI therapy and early multi-target radiotherapy are very effective in selected patients that respond to TKI, when the status of mutations in the epidermal growth factor receptor (EGFR) are not known before the treatment. Our data may aid expansion of the effectiveness of TKI treatment through radiotherapy in Asian patients with stage IV NSqCLC.

• Authors: Chih-Chia Chang, Kwan-Hwa Chi, Shang-Jyh Kao, Pei-Sung Hsu, Yuk-Wah Tsang, Heng-Jui Chang, Yu-Wung Yeh, Yei-San Hsieh, Jiunn-Song Jiang
• Journal: Lung cancer (Amsterdam, Netherlands) (Lung Cancer) Vol. 73 Issue 2 Pg. 189-94 (Aug 2011) ISSN: 1872-8332 [Electronic] Ireland
• PMID: 21247653 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Protein Kinase Inhibitors
• Quinazolines
• Erlotinib Hydrochloride
• Gefitinib

Topics

• Adenocarcinoma (drug therapy, mortality, pathology, radiotherapy)
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Bone Neoplasms (secondary)
• Carcinoma, Non-Small-Cell Lung (drug therapy, mortality, pathology, radiotherapy)
• Combined Modality Therapy
• Disease-Free Survival
• Erlotinib Hydrochloride
• Female
• Gefitinib
• Heart Neoplasms (secondary)
• Humans
• Kaplan-Meier Estimate
• Lung Neoplasms (drug therapy, mortality, pathology, radiotherapy)
• Lymphatic Metastasis
• Male
• Middle Aged
• Pleural Neoplasms (secondary)
• Protein Kinase Inhibitors (administration & dosage)
• Quinazolines (administration & dosage)
• Treatment Outcome