Erlotinib, chemotherapy both effective for second-line NSCLC treatment
MedWire News: Erlotinib, docetaxel, and pemetrexed have comparable efficacy for treating patients with refractory non-small-cell lung cancer (NSCLC), suggest findings from the Tarceva In Treatment of Advanced NSCLC (TITAN) trial.
The epidermal growth factor receptor (EGFR) inhibitor and the two chemotherapy agents are all approved for second-line treatment of NSCLC, but until now no large studies had assessed their comparative efficacy.
For the phase III trial, conducted in 24 countries, 424 NSCLC patients with disease progression following first-line treatment with platinum doublet chemotherapy were randomly assigned to receive erlotinib 150 mg/day or chemotherapy (standard docetaxel or pemetrexed regimens).
Patients were followed up for a median of 27.9 months after receiving erlotinib and 24.8 months after chemotherapy. Findings showed that median overall survival (OS) and 1-year OS were comparable for both groups, at 5.3 months and 26% for erlotinib, and 5.5 months and 24% for chemotherapy.
Median progression-free survival was also comparable for patients treated with erlotinib compared with chemotherapy (6.3 vs 8.6 weeks).
In addition, the proportion of patients with a partial response was similar for both treatment groups, at 7.9% for erlotinib and 6.3% for chemotherapy, report Tudor Ciuleanu (Institute of Oncology Ion Chiricuta, Cluj-Napoca, Romania) and colleagues. Patients with tumors that were positive for EGFR did not benefit more from erlotinib than chemotherapy.
Analysis of adverse events showed that rash and diarrhea were most common with erlotinib, whereas alopecia was the most common treatment-related adverse event with chemotherapy.
Fewer patients in the erlotinib group compared with the chemotherapy group experienced serious hematologic events such as anemia, neutropenia, and febrile neutropenia, although there was a higher incidence of pulmonary embolism in the erlotinib group.
"Given the lack of difference in efficacy between erlotinib and chemotherapy for the second-line treatment of patients with advanced NSCLC, the safety of the available second-line treatment options should be taken into consideration, taking into account factors such as patient preference and patients' differing risk profiles for specific toxicities," conclude the researchers in The Lancet Oncology.
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By Ingrid Grasmo