Tuberc Respir Dis.  2017 Apr;80(2):187-193. 10.4046/trd.2017.80.2.187.

Predictive Factors for Switched EGFR-TKI Retreatment in Patients with EGFR-Mutant Non-Small Cell Lung Cancer

• Kwon BS
• Park JH
• Kim WS
• Song JS
• Choi CM
• Rho JK
• Lee JC

• KMID: 2375988
• DOI: http://doi.org/10.4046/trd.2017.80.2.187

Abstract

BACKGROUND
Third-generation tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR-TKIs) have proved efficacious in treating non-small cell lung cancer (NSCLC) patients with acquired resistance resulting from the T790M mutation. However, since almost 50% patients with the acquired resistance do not harbor the T790M mutation, retreatment with first- or second-generation EGFR-TKIs may be a more viable therapeutic option. Here, we identified positive response predictors to retreatment, in patients who switched to a different EGFR-TKI, following initial treatment failure.
METHODS
This study retrospectively reviewed the medical records of 42 NSCLC patients with EGFR mutations, whose cancers had progressed following initial treatment with gefitinib or erlotinib, and who had switched to a different first-generation EGFR-TKI during subsequent retreatment. To identify high response rate predictors in the changed EGFR-TKI retreatment, we analyzed the relationship between clinical and demographic parameters, and positive clinical outcomes, following retreatment with EGFR-TKI.
RESULTS
Overall, 30 (71.4%) patients received gefitinib and 12 (28.6%) patients received erlotinib as their first EGFR-TKI treatment. Following retreatment with a different EGFR-TKI, the overall response and disease control rates were 21.4% and 64.3%, respectively. There was no significant association between their overall responses. The median progression-free survival (PFS) after retreatment was 2.0 months. However, PFS was significantly longer in patients whose time to progression was ≥10 months following initial EGFR-TKI treatment, who had a mutation of exon 19, or whose treatment interval was <90 days.
CONCLUSION
In patients with acquired resistance to initial EGFR-TKI therapy, switched EGFR-TKI retreatment may be a salvage therapy for individuals possessing positive retreatment response predictors.

Keyword

Carcinoma, Non-Small-Cell Lung; Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor; Retreatment; Predictive

MeSH Terms

Carcinoma, Non-Small-Cell Lung*
Disease-Free Survival
Erlotinib Hydrochloride
Exons
Humans
Medical Records
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor
Retreatment*
Retrospective Studies
Salvage Therapy
Treatment Failure
Erlotinib Hydrochloride
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor

Figure

• 

  Figure 1 (A) Progression-free survival of second epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) by time to progression (TTP). (B) Progression-free survival of second EGFR-TKI by interval duration. (C) Progression-free survival of second EGFR-TKI by EGFR mutation subtype.

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