Factors associated with improvement in symptoms and quality of life for first-line EGFR-tyrosine kinase inhibitor treatment in patients with EGFR-mutated non-small-cell lung cancer - A multicenter prospective SMILE study

Yu-Feng Wei, Wen-Tsung Huang, Tu-Chen Liu, Jiunn-Min Shieh, Chih-Feng Chian, Ming-Fang Wu, Chih-Cheng Chang, Ching-Hsiung Lin, Jen-Chung Ko, Chia-Mo Lin, Te-Chun Hsia, Yu-Feng Wei, Wen-Tsung Huang, Tu-Chen Liu, Jiunn-Min Shieh, Chih-Feng Chian, Ming-Fang Wu, Chih-Cheng Chang, Ching-Hsiung Lin, Jen-Chung Ko, Chia-Mo Lin, Te-Chun Hsia

Abstract

Introduction: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are a standard first-line treatment for advanced EGFR-mutated NSCLC patients. Factors associated with symptoms and quality of life (QOL) improvements have not been investigated. Methods: We conducted a multicenter, prospective study to evaluate improvements in QOL and symptoms in NSCLC patients treated with first-line EGFR-TKIs. QOL was assessed using the instrument of Functional Assessment of Cancer Therapy-Lung questionnaire (FACT-L) and Treatment Outcome Index (TOI). Assessment of symptoms was evaluated using the Lung cancer subscale (LCS). Results: Eligible subjects included 280 patients for endpoint analyses. The mean FACT-L score increased by 4.0 ± 15.56 at Week 2 (p<0.001), 5.1 ± 18.48 at Week 4 (p<0.001), and 4.2 ± 20.27 at Week 12 (p=0.001). Similarly, a 2.3 ± 11.65 (p<0.001), 3.2 ± 13.59 (p<0.001), and 2.4 ± 14.34 (p=0.009) increase in mean TOI score were observed at Weeks 2, 4 and 12, respectively. For LCS, it was slightly increased by 1.7 ± 4.61, 2.0 ± 5.50, and 2.0 ± 5.36 at Weeks 2, 4, and 12 (all p<0.001), respectively. Subgroup analyses showed patients who were ex-smokers or with at least 3 metastatic sites were associated with symptoms improvement. Patients who were ex-smokers, with at least 3 metastatic sites, a PS of 1, or treated with gefitinib were associated with QOL improvement. Conclusions: In EGFR -mutated NSCLC patients who were treated with first-line EGFR-TKIs, these ex-smokers or with 3 or more metastatic sites were associated with improvements in symptoms and QOL.

Keywords: epidermal growth factor receptor tyrosine kinase inhibitor; non-small cell lung cancer; quality of life.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Subgroup analyses for clinically meaningful improvement (LCS ≧ 2 points from baseline score). a) gender; b) smoking status; c) WHO performance status, d) number of metastatic sites and e) EGFR-TKI therapy. LCS = Lung cancer subscale; EGFR-TKI = epidermal growth factor receptor-tyrosine kinase inhibitor
Figure 1
Figure 1
Subgroup analyses for clinically meaningful improvement (LCS ≧ 2 points from baseline score). a) gender; b) smoking status; c) WHO performance status, d) number of metastatic sites and e) EGFR-TKI therapy. LCS = Lung cancer subscale; EGFR-TKI = epidermal growth factor receptor-tyrosine kinase inhibitor
Figure 1
Figure 1
Subgroup analyses for clinically meaningful improvement (LCS ≧ 2 points from baseline score). a) gender; b) smoking status; c) WHO performance status, d) number of metastatic sites and e) EGFR-TKI therapy. LCS = Lung cancer subscale; EGFR-TKI = epidermal growth factor receptor-tyrosine kinase inhibitor
Figure 1
Figure 1
Subgroup analyses for clinically meaningful improvement (LCS ≧ 2 points from baseline score). a) gender; b) smoking status; c) WHO performance status, d) number of metastatic sites and e) EGFR-TKI therapy. LCS = Lung cancer subscale; EGFR-TKI = epidermal growth factor receptor-tyrosine kinase inhibitor
Figure 1
Figure 1
Subgroup analyses for clinically meaningful improvement (LCS ≧ 2 points from baseline score). a) gender; b) smoking status; c) WHO performance status, d) number of metastatic sites and e) EGFR-TKI therapy. LCS = Lung cancer subscale; EGFR-TKI = epidermal growth factor receptor-tyrosine kinase inhibitor
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05
Figure 2
Figure 2
Change in TOI (a-e) and FACT-L (f-j) from baseline by subgroups. FACT-L = Functional Assessment of Cancer Therapy-Lung questionnaire; TOI = Treatment Outcome Index. * Score changes from baseline with p-value < 0.05

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Source: PubMed

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