6 juni 2012: link naar het volledige studie rapport van deze studie onderaan dit artikel toegevoegd

20 januari 2011: Bron: Science direct: doi:10.1016/j.lungcan.2010.12.006

EGRF remmers zoals met name Iressa en Tarceva blijken uitstekend te werken voor longkankerpatienten met de juiste expressie van hun tumoren. De mediane levensduur en kwaliteit van leven verbetert significant in vergelijking met chemo. Maar zelfs voor mensen met longkanker waarvan de expressie niet kan worden vastgesteld zijn beter af met Iressa of Tarceva in vergeljiking met chemo omdat de levensduur en kwaliteit van leven minimaal gelijk bleef in vergelijking met de chemogroep. Echter deze bedroeg voor beide groepen tussen de 2 en 6 maanden maximaal. terwijl voor de patienten met de juiste expressie de levensduur mediaan 18 maanden bedraagt en sommigen vele jaren met hun longkanker kunnen leven met goede kwaliteit van leven. Medscape analyseerde de grote overzichtstudie van alle zo ver bekende gerandomiseerde fase II en fase III studies.  Klik hier voor Medscape artikel.

Five studies used EGFR inhibitors (gefitinib or erlotinib; n = 330) and 10 used a single chemotherapeutic agent (paclitaxel, docetaxel, gemcitabine or vinorelbine; n = 1,095). The authors note that none involved a direct head-to-head comparison of the two drug classes.

Dr.Jianqing Wu of Nanjing Medical University, Jiangsu, and colleagues found unsurprisingly that tumors harboring EGFR mutations did best on EGFR antagonists, with a 66% response rate, a 90% disease control rate, and a median survival of nearly 18 months.

Unselected patients fared worse, and nearly equally so, in pooled response rate (6% for EGFR inhibitors vs. 9% for chemotherapy) and in median survival (3.7 to 6.6 months for EGFR inhibitors vs. 2.1 to 8.2 months for chemotherapy).

However, gefitinib or erlotinib were associated with better disease control rates: 40% vs 30%.

Chemotherapeutics were associated with higher incidence of hematologic toxicity (anemia, neutropenia, and thrombocytopenia), while EGFR inhibitors resulted in more frequent non-hematological adverse events (diarrhea, skin damage, elevated serum transaminase, and interstitial lung disease).

But in terms of quality of life, EGFR inhibitors had a clear edge: only two of five chemotherapy trials that included such data reported an improvement, compared to all four EGFR inhibitor studies.

Hier het abstract van de studie. Het volledige studie rapport: The safety and efficacy of EGFR TKIs monotherapy versus single-agent chemotherapy using third-generation cytotoxics as the first-line treatment for patients with advanced non-small cell lung cancer and poor performance status is hier tegen betaling in te zien.

EGFR TKIs tended to be more effective in control of tumor progression, reduction of therapy-related toxicities, improvement of symptoms or quality-of-life in the first-line treatments of ANSCLC patients with poor PS

Lung Cancer
Volume 73, Issue 2 , Pages 203-210, August 2011

Summary 

Purpose

To assess the risk/benefit profiles of EGFR TKIs monotherapy using erlotinib or gefitinib in comparison with single-agent chemotherapy using third-generation cytotoxics (gemcitabine, vinorelbine, taxanes) as the first-line treatment for chemonaÏve patients with advanced non-small cell lung cancer (ANSCLC) and poor performance status (PS).

Methods

A pooled analysis and systematic review was performed using trials identified through MEDLINE, EMBASE, Cochrane Library, and the Clinical-Trials.gov. Data were collected from randomized and non-randomized phase II or III clinical trials of EGFR TKIs monotherapy or single-agent chemotherapy using third-generation cytotoxics published before 3/1/2010, and the pooled estimates for efficacy and safety outcomes of interest were calculated.

Results

Fifteen eligible trials (1425 patients) were selected from 323 studies that initially were identified. In 5 of the selected single-agent chemotherapy studies, the elderly were included together with poor PS patients. Outcomes from these studies still were employed for a thorough analysis. Targeting poor PS patients, we found that the pooled response rate (95% confidence interval) to EGFR TKIs for unselected population was 6% (3–8%), not substantially different from 9% (6–13%) reported by single-agent chemotherapy trials using third-generation cytotoxics. However, EGFR TKIs had better disease control rates with a pooled estimate of 40% (33–47%), significantly higher than 30% (20–41%) of the cytotoxics. Single-agent chemotherapy trials enrolling both elderly and poor PS patients had better results with the pooled response rate and the pooled disease control rate was 13% (11–16%) and 41% (36–46%) respectively. For safety information, despite both treatments were well-tolerated, the toxicity profile of EGFR TKIs was clearly more favorable than that reported by chemotherapy. The severe hematological adverse events related to EGFR TKIs treatment were rare. EGFR TKIs also tended to be more effective in improvement of symptoms or quality-of-life (QOL).

Conclusion

Although, both of the treatments had low response rates, EGFR TKIs tended to be more effective in control of tumor progression, reduction of therapy-related toxicities, improvement of symptoms or quality-of-life in the first-line treatments of ANSCLC patients with poor PS. Moreover, our data also suggest that the elderly patients without selection carefully according their PS should be separated from this population. Further investigations with valid comparison groups are necessary.


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