Randomized phase II trial of erlotinib alone or with carboplatin and paclitaxel in patients who were never or light former smokers with advanced lung adenocarcinoma: CALGB 30406 trial.

Abstract

PURPOSE:

Erlotinib is clinically effective in patients with non-small-cell lung cancer (NSCLC) who have adenocarcinoma, are never or limited former smokers, or have EGFR mutant tumors. We investigated the efficacy of erlotinib alone or in combination with chemotherapy in patients with these characteristics.

PATIENTS AND METHODS:

Patients with advanced NSCLC (adenocarcinoma) who were epidermal growth factor receptor tyrosine kinase inhibitor and chemotherapy naive never or light former smokers (smokers of > 100 cigarettes and ≤ 10 pack years and quit ≥ 1 year ago) were randomly assigned to continuous erlotinib or in combination with carboplatin and paclitaxel (ECP) for six cycles followed by erlotinib alone. The primary end point was progression-free survival (PFS). Tissue collection was mandatory.

RESULTS:

PFS was similar (5.0 v 6.6 months; P = .1988) in patients randomly assigned to erlotinib alone (arm A; n = 81) or to ECP (arm B; n = 100). EGFR mutation analysis was possible in 91% (164 of 181) of patients, and EGFR mutations were detected in 40% (51 of 128) of never smokers and in 42% (15 of 36) of light former smokers. In arm A, response rate (70% v 9%), PFS (14.1 v 2.6 months), and overall survival (OS; 31.3 v 18.1 month) favored EGFR-mutant patients. In arm B, response rate (73% v 30%), PFS (17.2 v 4.8 months), and OS (38.1 v 14.4 months) favored EGFR-mutant patients. Incidence of grades 3 to 4 hematologic (2% v 49%; P < .001) and nonhematologic (24% v 52%; P < .001) toxicity was greater in patients treated with ECP.

CONCLUSION:

Erlotinib and erlotinib plus chemotherapy have similar efficacy in clinically selected populations of patients with advanced NSCLC. EGFR mutations identify patients most likely to benefit.

• Authors: Pasi A Jänne, Xiaofei Wang, Mark A Socinski, Jeffrey Crawford, Thomas E Stinchcombe, Lin Gu, Marzia Capelletti, Martin J Edelman, Miguel A Villalona-Calero, Robert Kratzke, Everett E Vokes, Vincent A Miller
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 30 Issue 17 Pg. 2063-9 (Jun 10 2012) ISSN: 1527-7755 [Electronic] United States
• PMID: 22547605 (Publication Type: Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial)

Chemical References

• Placebos
• Quinazolines
• Carboplatin
• Erlotinib Hydrochloride
• ErbB Receptors

Topics

• Adenocarcinoma (drug therapy)
• Adenocarcinoma of Lung
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carboplatin (administration & dosage)
• Disease-Free Survival
• ErbB Receptors (genetics)
• Erlotinib Hydrochloride
• Female
• Humans
• Lung Neoplasms (drug therapy)
• Male
• Middle Aged
• Placebos
• Quinazolines (administration & dosage)
• Smoking (adverse effects)