Cancer Res Treat.  2019 Apr;51(2):493-501. 10.4143/crt.2018.125.

EGFR Mutation Is Associated with Short Progression-Free Survival in Patients with Stage III Non-squamous Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

• Park SE
• Noh JM
• Kim YJ
• Lee HS
• Cho JH
• Lim SW
• Ahn YC
• Pyo H
• Choi YL
• Han J
• Sun JM
• Lee SH
• Ahn JS
• Park K
• Ahn MJ

• KMID: 2464396
• DOI: http://doi.org/10.4143/crt.2018.125

Abstract

PURPOSE
This study was conducted to evaluate the relationship between epidermal growth factor receptor (EGFR) mutation and clinical outcomes in patients with stage III non-squamous cell lung cancer treated with definitive concurrent chemoradiotherapy (CCRT).
MATERIALS AND METHODS
From January 2008 to December 2013, the medical records of 197 patients with stage III non- squamous non-small cell lung cancer treated with definitive CCRT were analyzed to determine progression-free survival (PFS) and overall survival (OS) according to EGFR mutation status.
RESULTS
Among 197 eligible patients, 81 patients were EGFR wild type, 36 patients had an EGFR mutation (exon 19 Del, n=18; L858R, n=9, uncommon [G719X, L868, T790M], n=9), and 80 patients had unknown EGFR status. The median age was 59 years (range, 28 to 80 years) and 136 patients (69.0%) were male. The median follow-up duration was 66.5 months (range, 1.9 to 114.5 months). One hundred sixty-four patients (83.2%) experienced disease progression. Median PFS was 8.9 months for the EGFR mutation group, 11.8 months for EGFR wild type, and 10.5 months for the unknown EGFR group (p=0.013 and p=0.042, respectively). The most common site of metastasis in the EGFR mutant group was the brain. However, there was no significant difference in OS among the three groups (34.6 months for EGFR mutant group vs. 31.9 months for EGFR wild type vs. 22.6 months for EGFR unknown group; p=0.792 and p=0.284). A total of 29 patients (80.6%) with EGFR mutation were treated with EGFR tyrosine kinase inhibitor (gefitinib, n=24; erlotinib, n=3; afatinib, n=2) upon progression.
CONCLUSION
EGFR mutation is associatedwith short PFS and the brain is the most common site of distant metastasis in patients with stage III non- squamous cell lung cancer treated with CCRT.

Keyword

Non-squamous non-small cell lung cancer; Chemoradiotherapy; Stage III; EGFR mutation; Survival

MeSH Terms

Brain
Carcinoma, Non-Small-Cell Lung
Chemoradiotherapy*
Disease Progression
Disease-Free Survival*
Epithelial Cells
Erlotinib Hydrochloride
Follow-Up Studies
Humans
Lung Neoplasms*
Lung*
Male
Medical Records
Neoplasm Metastasis
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor
Erlotinib Hydrochloride
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor

Figure

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  Fig. 1. Study pilot. NSCLC, non-small lung carcinoma; CCRT, concurrent chemoradiotherapy.

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  Fig. 2. Kaplan-Meier survival curves of progression-free survival (A) and overall survival (B) according to epidermal growth factor receptor (EGFR) mutation status. HR, hazard ratio; CI, confidence interval.

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  Fig. 3. Kaplan-Meier survival curves of subgroup analysis according to epidermal growth factor receptor (EGFR) mutation status. (A) Progression-free survival. (B) Overall survival. HR, hazard ratio; CI, confidence interval.

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  Fig. 4. Kaplan-Meier survival curves of loco-regional recurrence free survival (A) and distant metastasis free survival (B). EGFR, epidermal growth factor receptor; HR, hazard ratio; CI, confidence interval.

Reference

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