Author of

• 12648

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  P3.11 - Poster Session 3 - NSCLC Novel Therapies (ID 211)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12660

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    P3.11-012 - Epidermal growth factor receptor tyrosine kinase inhibitors in advanced squamous cell carcinoma of the lung. (ID 1267)

    09:30 - 09:30  |  Author(s): V. Gebski
    • Abstract

    Background
    Tyrosine Kinase inhibitors (TKIs) with gefitinib or erlotinib targeting the epidermal-growth factor receptor (EGFR) are a well-established therapy in the treatment of metastatic pulmonary adenocarcinoma, particularly in patients with activating EGFR mutations. EGFR mutations are rarely found in squamous cell carcinomas (SCC) of the lung. There is conflicting data supporting the efficacy of EGFR inhibitors in advanced SCC of the lung. In this analysis we examined the impact of EGFR TKIs on progression-free survival (PFS) and overall survival (OS) in unselected patients with SCC of the lung.

    Methods
    We searched for Randomised controlled trials (RCTs) comparing EGFR-TKIs alone with placebo (PL) in patients with metastatic non-small cell lung cancer. RCTs in the front-line, maintenance and subsequent therapies were included. The primary outcome was PFS in the SCC population. We used published hazard ratios (HRs), and when not available unpublished data was sought. Non-adenocarcinoma was used as a surrogate for SCC when analysis was available by specific histology. Pooled estimates of treatment effect on OS and PFS were calculated using the random-effects inverse variance weighted method.

    Results
    Eight eligible RCTs were included: 2 first line, 6 second-line or beyond, evaluating 1781 patients (EGFR TKI v PL). Data was available for analysis of OS in 4 studies (second-line; N = 1420) and for PFS in 4 studies (three second-line, one first-line; N = 788). EGFR TKIs significantly prolonged PFS, with a hazard ratio of 0.77 [95% CI 0.65 – 0.92]. OS was prolonged with a hazard ratio of 0.88 [95% confidence interval (CI) 0.78 – 1.00]. Efforts to obtain further missing data from the other studies to complement the analysis are on-going.

    Conclusion
    EGFR mutations are rare in SCC of the lung, yet EGFR TKIs have a significant PFS benefit and (less certain) OS benefit compared to placebo in unselected patients with advanced pulmonary SCC, and should be considered as a therapeutic option in patients with advanced SCC of the lung. EGFR mutation independent mechanisms may explain efficacy of EGFR inhibitors in this setting. An individual patient data meta-analysis is warranted to further characterize the OS benefit.