Abstract
Small molecule tyrosine kinase inhibitors (TKIs) have transformed the management of advanced non-small-cell lung cancer (NSCLC) harboring activating epithelial growth factor receptor (EGFR) mutations, while the efficacy of TKIs in the adjuvant setting remains unclear. We collected the data of 209 EGFR-mutant NSCLC patients receiving complete resection from 2010 to 2013. Study end points were disease-free survival (DFS) and overall survival (OS). Among the eligible patients, 41 (19.6%) received EGFR TKIs in the adjuvant treatment. The 3-year DFS of adjuvant EGFR TKIs treatment group (70.5%, 95% CI, 54.6–86.4%) was significantly superior that control group (50.2%, 95% CI, 40–60.4%; log-rank P = 0.014). TKIs treatment (HR, 0.51; 95% CI, 0.29–0.97; P = 0.04) was significantly associated with improved DFS in multivariate Cox analysis. No significant difference was observed in 3-year OS between two groups (73.1% [58.0–88.2%] vs 61.8% [52.2–71.4%], log-rank P = 0.21). Propensity-score matching further confirmed that adjuvant TKIs treatment extended the DFS (log-rank P = 0.024), but did not improve OS (log-rank P = 0.40). Our analysis revealed that adjuvant EGFR TKIs treatment was beneficial for early-stage NSCLC patients harboring activating EGFR mutations after complete resection.
Highlights
Lung cancer is the most common malignancy, and is the lead cause of cancer-related mortality worldwide[1]
The meta-analysis by the Lung Adjuvant Cisplatin Evaluation (LACE) collaborative group demonstrated that adjuvant cisplatin-based chemotherapy significantly reduced disease recurrence and improved the survival of completely resected nonsmall-cell lung cancer (NSCLC) patients[11], and it has been recommended as routine clinical practice by major organizations
A total of 209 NSCLC patients harboring epithelial growth factor receptor (EGFR) activating mutations were included in the study cohort
Summary
A total of 209 NSCLC patients harboring EGFR activating mutations were included in the study cohort. The 3-year DFS of patients in the adjuvant EGFR TKIs treatment group and the control group were 70.5% (95% CI, 54.6–86.4%) and 50.2% (95% CI, 40–60.4%), respectively (Fig. 1A). On multivariate analysis, adjusted for age, gender, smoking status, pathologic stage and adjuvant chemotherapy, adjuvant EGFR TKIs treatment was significantly associated with improved DFS (HR, 0.51; 95% CI, 0.29–0.97; P = 0.04; Table 2). On multivariate Cox regression analysis, adjusted for age, gender, smoking status, pathologic stage and adjuvant chemotherapy, adjuvant EGFR TKIs treatment was not associated with OS (HR, 0.78; 95% CI, 0.44–1.41; P = 0.41; Table 2). The DFS of patients receiving adjuvant EGFR TKIs treatment was significantly superior to that of control group (log-rank P = 0.024, Fig. 2A).
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