Treatment tactics of non-small-cell lung cancer with erlotinib: literature review and description of a clinical case
https://doi.org/10.21518/2079-701X-2019-19-38-43
Abstract
Erlotinib is a small-molecule inhibitor of EGFR tyrosine kinase domain, which has shown effectiveness in the treatment of non-small cell lung cancer with activating EGFR mutation. A number of large randomized studies have shown a significant increase in survival without progression in the use of erlotinib and other tyrosine kinase inhibitors in comparison with standard chemotherapy. At the same time, there were no differences in the overall survival rate, which is due to the high frequency of tyrosine kinase inhibitors use in subsequent therapy lines in patients who had progression during the first-line chemotherapy. At the same time, this retrospective study showed an obvious (more than doubling) increase in the overall survival rate of patients receiving treatment with tyrosine kinase inhibitors as compared to historical control. There were no significant differences between the first and second generation tyrosine kinase inhibitors. Mutation of T790M is one of the main mechanisms of resistance to erlotinib. When progressing against the background of erlotinib treatment, the third generation tyrosine kinase inhibitor osimertinib is effective in case of T790M mutation detection. The combination of erlotinib with bevacizumab leads to an increase in survival without progression, without affecting the overall survival rate. The combined use of chemotherapy and tyrosine kinase inhibitors requires further study. An example of a long-term effect on the background of erlotinib treatment in a patient with non-small-cell lung cancer of stage IV with EGFR mutation is given. The total duration of treatment was 68 months, including the therapy with erlotinib in combination with bevacizumab and local radiation therapy on the progression zone (rib metastasis), which lasted for 21 months against the background of the indolent course of the disease.
About the Authors
E. I. Borisova
Federal State Budgetary Institution «N.N. Blokhin Russian Cancer Research Center» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Cand. of Sci. (Med), Senior Researcher
23, Kashirskoye sh., Moscow, 115478, Russia
S. L. Gutorov
Federal State Budgetary Institution «N.N. Blokhin Russian Cancer Research Center» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Dr. of Sci. (Med), Leading Researcher
23, Kashirskoye sh., Moscow, 115478, Russia
M. E. Abramov
Federal State Budgetary Institution «N.N. Blokhin Russian Cancer Research Center» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Cand. of Sci. (Med), Leading Researcher
23, Kashirskoye sh., Moscow, 115478, Russia
References
1. Kaprin A.D., Starinskiy V.V., Petrova G.V. (eds.). Malignant neoplasms in Russia in 2016 (morbidity and mortality). Moscow: P. A. Gertsen MROI branch of the FSBI «NMRC of Radiology of the Ministry of Health of the Russian Federation; 2018. 250 c. (In Russ.) Available at: http://www.oncology.ru/service/statistics/malignant_tumors/2016.pdf.
2. Jackman D.M., Zhang Y., Dalby C., Nguyen T., Nagle J., Lydon C.A. et al. Cost and Survival Analysis Before and After Implementation of Dana-Farber Clinical Pathways for Patients With Stage IV Non-Small-Cell Lung Cancer. J Oncol Pract. 2017;13(4):e346-e352. doi: 10.1200/JOP.2017.021741.
3. Zhao D., Chen X., Qin N., Su D., Zhou L., Zhang Q. et al. The prognostic role of EGFR-TKIs for patients with advanced non-small cell lung cancer. Sci Rep 2017;12:40374. doi: 10.1038/srep40374.
4. Zhang Y.L., Yuan J.Q., Wang K.F., Fu X.H., Han X.R., Threapleton D. et al. The prevalence of EGFR mutation in patients with non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget. 2016;7(48):78985-78993. doi: 10.18632/oncotarget.12587.
5. Zhou C., Wu Y.L., Chen G., Feng J., Liu X.Q., Wang C. et al. Final overall survival results from a randomised, phase III study of erlotinib versus chemotherapy as first-line treatment of EGFR mutation-positive advanced non-small-cell lung cancer
6. (OPTIMAL, CTONG-0802). Ann Oncol. 2015;26(9):1877-1883. doi: 10.1093/annonc/mdv276.
7. Wu Y.L., Zhou C., Liam C.K., Wu G., Liu X., Zhong Z. et al. First-line erlotinib versus gemcitabine/cisplatin in patients with advanced EGFR mutation-positive non-small-cell lung cancer: analyses from the phase III, randomized, open-label, ENSURE study. Ann Oncol. 2015;26(9):1883-1889. doi: 10.1093/annonc/mdv270.
8. Rosell R., Carcereny E., Gervais R., Vergnenegre A., Massuti B., Felip E. et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13(3):239-246. doi: 10.1016/S1470-2045(11)70393-X.
9. Lee C.K., Brown C., Gralla R.J., Hirsh V., Thongprasert S., Tsai C.M. et al. Impact of EGFR inhibitor in non-small cell lung cancer on progression-free and overall survival: a meta-analysis. J Natl Cancer Inst. 2013;105(9):595-605. doi: 10.1093/jnci/djt072.
10. Urata Y., Katakami N., Morita S., Kaji R., Yoshioka H., Seto T. et al. Randomized Phase III Study Comparing Gefitinib With Erlotinib in Patients With Previously Treated Advanced Lung Adenocarcinoma: WJOG 5108L. J Clin Oncol. 2016;34(27):3248-3257. doi: 10.1200/JCO.2015.63.4154.
11. Borisova E.I., Gutorov S.L. Сomparative analysis of adverse events of EGFR tyrosine kinase inhibitor therapy in non-small cell lung cancer. Ehffektivnaya farmakoterapiya = Effective pharmacotherapy. 2018;(5):34-39. (In Russ.) Available at: https://elibrary.ru/item.asp?id=32693625.
12. Yang J.J., Zhou Q., Yan H.H., Zhang X.C., Chen H.J., Tu H.Y. et al. A phase III randomised controlled trial of erlotinib vs gefitinib in advanced non-small cell lung cancer with EGFR mutations. Br J Cancer. 2017;116(5):568-574. doi: 10.1038/bjc.2016.456.
13. Yang J.C.-H., Wu Y.-L., Schuler M., Sebastian M., Popat S., Yamamoto N.,et al. Afatinib versus cisplatin based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol. 2015;16(2):141–151. doi: 10.1016/S1470-2045(14)71173-8.
14. Paz-Ares L., Tan E.H., O’Byrne K., Zhang L., Hirsh V., Boyer M. et al. Afatinib versus gefitinib in patients with EGFR mutation-positive advanced non-small-cell lung cancer: overall survival data from the phase IIb LUX-Lung 7 trial. Ann Oncol. 2017;28(2):270-277. doi: 10.1093/annonc/mdw611.
15. Mok T.S., Wu Y.-L., Ahn M.-J., Garassino M.C., Kim H.R., Ramalingam S.S. et al. Osimertinib or Platinum-Pemetrexed in EGFR T790MPositive Lung Cancer. N Engl J Med. 2017;376(7):629-640. doi: 10.1056/NEJMoa1612674.
16. Nishie K., Kawaguchi T., Tamiya A., Mimori T., Takeuchi N., Matsuda Y. et al. Epidermal growth factor receptor tyrosine kinase inhibitors beyond progressive disease: a retrospective analysis for Japanese patients with activating EGFR mutations. J Thorac Oncol. 2012;7(11):1722-1727. doi: 10.1097/JTO.0b013e31826913f7.
17. Seto T., Kato T., Nishio M., Goto K., Atagi S., Hosomi Y. et al. Erlotinib alone or with bevacizumab as first-line therapy in patients with advanced non-squamous non-small-cell lung cancer harbouring EGFR mutations (JO25567): an open-label, randomised, multicentre, phase 2 study. Lancet Oncol. 2014;15(11):1236-1244. doi: 10.1016/S1470-2045(14)70381-X.
18. Saito H., Fukuhara T., Furuya N., Watanabe K., Sugawara S., Iwasawa S. et al. Erlotinib plus bevacizumab versus erlotinib alone in patients with EGFR-positive advanced nonsquamous non-small-cell lung cancer (NEJ026): interim analysis of an open-label, randomised, multicentre, phase 3 trial. Lancet Oncol. 2019;20(5):625-635. doi: 10.1016/S1470-2045(19)30035-X.
19. Noronha V., Patil V.M., Joshi A., Menon N., Chougule A., Mahajan A. et al. Gefitinib Versus Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR-Mutated Lung Cancer. J Clin Oncol. 2019:JCO1901154. doi: 10.1200/JCO.19.01154.
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For citations:
Borisova EI, Gutorov SL, Abramov ME. Treatment tactics of non-small-cell lung cancer with erlotinib: literature review and description of a clinical case. Meditsinskiy sovet = Medical Council. 2019;(19):38-43. (In Russ.) https://doi.org/10.21518/2079-701X-2019-19-38-43
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