Overall survival in stage IV EGFR mutationpositive NSCLC: Comparing first, second and thirdgeneration EGFRTKIs (Review).
Int J Oncol
; 58(2): 171-184, 2021 02.
Article
em En
| MEDLINE
| ID: mdl-33491758
ABSTRACT
A substantial (4060%) proportion of patients with nonsmall cell lung carcinoma (NSCLC) have epidermal growth factor receptor (EGFR) mutations, a crucial therapeutic target in NSCLC. Treatment strategies for patients with advancedstage NSCLC have markedly changed, from the empirical use of cytotoxic agents to targeted regimens. EGFR tyrosine kinase inhibitors (TKIs), the firstline therapy for advanced NSCLC, are reported to be the most effective. Although progressionfree survival (PFS) and objective response rates have long been used as endpoints, meeting these endpoints may not necessarily coincide with an increase in overall survival (OS) among patients with advanced lung cancer. Recently, the FLAURA study with the thirdgeneration, irreversible, oral EGFRTKI, osimertinib, demonstrated an extended median OS by 6.8 months compared with standard EGFRTKIs, with a 20% reduction in the risk of mortality [osimertinib, 38.6; EGFRTKIs, 31.8; hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.6410.997; P=0.046]; this was in addition to meeting the primary endpoint of clinically and statistically significant PFS. Osimertinib was also shown to lead to a statistically significant reduction in the risk of central nervous system disease progression (HR, 0.48; 95% CI, 0.260.86; P=0.014). Notably, 28% of patients remained on osimertinib treatment for 3 years, considerably longer than those in the comparator group (9%). The duration of first subsequent treatment with osimertinib was 25.5 months compared with 13.7 months with standard EGFRTKIs (HR, 0.478; 95% CI, 0.3930.581; P<0.0001). Thus, the longterm OS benefit with firstline osimertinib highlights a promising option in the management of stage IV NSCLC. The present narrative review compares the OS benefit of first, second and thirdgeneration EGFRTKIs for patients with stage IV EGFR mutationpositive NSCLC and discusses their role in disease management.
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Texto completo:
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Coleções:
01-internacional
Contexto em Saúde:
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Protocolos de Quimioterapia Combinada Antineoplásica
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Carcinoma Pulmonar de Células não Pequenas
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Inibidores de Proteínas Quinases
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Neoplasias Pulmonares
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
Limite:
Humans
Idioma:
En
Revista:
Int J Oncol
Ano de publicação:
2021
Tipo de documento:
Article