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Incorporating Erlotinib or Irinotecan Plus Cisplatin into Chemoradiotherapy for Stage III Non-small Cell Lung Cancer According to EGFR Mutation Status

Cancer Research and Treatment
2017년 49권 4호 p.981 ~ p.989
이영주 ( Lee Young-Joo ) - National Cancer Center Center for Lung Cancer

한지연 ( Han Ji-Youn ) - National Cancer Center Center for Lung Cancer
문성호 ( Moon Sung-Ho ) - National Cancer Center Proton Therapy Center
남병호 ( Nam Byung-Ho ) - National Cancer Center Center for Clinical Trials
임건영 ( Lim Kun-Young ) - National Cancer Center Center for Lung Cancer
이건국 ( Lee Geon-Kook ) - National Cancer Center Center for Lung Cancer
김흥태 ( Kim Heung-Tae ) - National Cancer Center Center for Lung Cancer
 ( Yun Tak ) - National Cancer Center Center for Lung Cancer
안혜진 ( An Hye-Jin ) - National Cancer Center Center for Lung Cancer
이진수 ( Lee Jin-Soo ) - National Cancer Center Center for Lung Cancer

Abstract

Purpose: Concurrent chemoradiotherapy (CCRT) is the standard care for stage III non-small cell lung cancer (NSCLC) patients; however, a more effective regimen is needed to improve the outcome by better controlling occult metastases. We conducted two parallel randomized phase II studies to incorporate erlotinib or irinotecan-cisplatin (IP) into CCRT for stage III NSCLC depending on epidermal growth factor receptor (EGFR) mutation status.

Materials and Methods: Patients with EGFR-mutant tumors were randomized to receive three cycles of erlotinib first and then either CCRT with erlotinib followed by erlotinib (arm A) or CCRT with IP only (arm B). Patients with EGFR unknown or wild-type tumors were randomized to receive either three cycles of IP before (arm C) or after CCRT with IP (arm D).

Results: Seventy-three patients were screened and the study was closed early because of slow accrual after 59 patients were randomized. Overall, there were seven patients in arm A, five in arm B, 22 in arm C, and 25 in arm D. The response rate was 71.4% and 80.0% for arm A and B, and 70.0% and 73.9% for arm C and D. The median overall survival (OS) was 39.3 months versus 31.2 months for arm A and B (p=0.442), and 16.3 months versus 25.3 months for arm C and D (p=0.050). Patients with sensitive EGFR mutations had significantly longer OS than EGFR-wild patients (74.8 months vs. 25.3 months, p=0.034). There were no unexpected toxicities.

Conclusion: Combined-modality treatment by molecular diagnostics is feasible in stage III NSCLC. EGFR-mutant patients appear to be a distinct subset with longer survival.
Key words: Chemoradiotherapy, EGFR tyrosine kinase inhibitor, EG

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