Intercalated combination of chemotherapy and erlotinib for stage IIIA non-small-cell lung cancer: a multicenter, open-label, single-arm, phase II study

Zhiwei Chen, Shengping Shen, Wenbo Shi, Gening Jiang, Xin Wang, Hong Jian, Zhen Zhou, Zhengping Ding, Shun Lu, Zhiwei Chen, Shengping Shen, Wenbo Shi, Gening Jiang, Xin Wang, Hong Jian, Zhen Zhou, Zhengping Ding, Shun Lu

Abstract

Objective: This multicenter, open-label, single-arm, phase II trial evaluated the efficacy and safety of an intercalated combination of erlotinib and gemcitabine/cisplatin or carboplatin in patients with stage IIIA non-small-cell lung cancer (NSCLC).

Registration: This trial is registered with ClinicalTrials.gov, number NCT01297101.

Methods: The primary endpoint was the objective response rate (ORR), which includes complete response (CR) and partial response (PR), assessed using RECIST version 1.0 in the intention-to-treat population. Adverse events (AEs) were graded by the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Secondary endpoints included the disease control rate, disease-free survival (DFS), overall survival (OS), and safety. Between April 1, 2011, and July 31, 2014, 39 patients with stage IIIA NSCLC received two cycles of intercalated use of erlotinib with gemcitabine/cisplatin or carboplatin.

Results: Eighteen patients (46.15%) achieved a PR and no patient achieved a pathologic CR, resulting in an ORR of 46.15% (95% CI 30-63%). Median DFS was 20 months (95% CI 5.26-50.61) and median OS was 25 months (95% CI 15.57-33.39). Patients with EGFR mutations (n=7) had a higher ORR than those with wild-type EGFR (n=9) (85.71% vs 55.56%, P=0.00). Most AEs were CTCAE grade 1 or 2; there were no cases of increased hematologic toxicity or erlotinib-emergent interstitial lung disease observed.

Conclusion: Two cycles of intercalated neoadjuvant therapy with erlotinib and gemcitabine/cisplatin or carboplatin were effective and safe for patients with stage IIIA NSCLC. This approach should be further explored in larger randomized controlled trials given the lack of a consensus about the best treatment for stage IIIA NSCLC.

Keywords: NSCLC; erlotinib; gemcitabine; neoadjuvant; non-small-cell lung cancer; objective response rate; overall survival; platinum; progression-free survival.

Conflict of interest statement

The authors report no conflicts of interest in regard to this work.

Figures

Figure 1
Figure 1
Waterfall plot of the largest percentage changes from baseline in the sum of the longest tumor diameters for stage IIIA NSCLC patients. Abbreviations: CR, complete response; NSCLC, non-small-cell lung cancer; PD, progressive disease; PR, partial response; SD, stable disease.
Figure 2
Figure 2
Kaplan-Meier curves for (A) disease-free survival (DFS) of the intention-to-treat population and (B) DFS of the intention-to-treat population stratified by EGFR mutational status. Abbreviation: CI, confidence interval.
Figure 3
Figure 3
Kaplan-Meier curves for (A) overall survival (OS) of the intention-to-treat population, (B) OS of the intention-to-treat population stratified by surgical resection versus no surgical resection, (C) OS of the intention-to-treat population stratified by EGFR mutational status, and (D) OS of surgical patients stratified by EGFR mutational status. Abbreviation: CI, confidence interval.

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