Sequential chemotherapy and icotinib as first-line treatment for advanced epidermal growth factor receptor-mutated non-small cell lung cancer

Abstract

BACKGROUND

Icotinib could have potential effect and tolerability when used sequentially with chemotherapy for advanced epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC).

AIM

To evaluate the efficacy and safety of chemotherapy followed by icotinib maintenance therapy as first-line treatment for advanced EGFR-mutated NSCLC.

METHODS

This multicenter, open-label, pilot randomized controlled trial enrolled 68 EGFR-mutated stage IIIB/IV NSCLC patients randomized 2:3 to the icotinib alone and chemotherapy + icotinib groups.

RESULTS

The median progression-free survival in the icotinib alone and chemotherapy + icotinib groups was 8.0 mo (95%CI: 3.84-11.63) and 13.4 mo (95%CI: 10.18-16.33), respectively (P = 0.0249). No significant differences were found in the curative effect when considering different cycles of chemotherapy or chemotherapy regimen (all P > 0.05).

CONCLUSION

A sequential combination of chemotherapy and EGFR-tyrosine kinase inhibitor is feasible for stage IV EGFR-mutated NSCLC patients.

Keywords: Advanced stage; Chemotherapy; Epidermal growth factor receptor mutation; First-line treatment; Icotinib

Core Tip: The combination of chemotherapy and epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) (concomitant or intercalated) generally showed improved efficacy compared with EGFR-TKI alone as the first-line treatment for advanced non-small cell lung cancer (NSCLC). This study aimed to evaluate the efficacy and safety of chemotherapy followed by icotinib maintenance therapy as first-line treatment for advanced EGFR-mutated NSCLC. Sixty-eight advanced NSCLC patients were randomized 2:3 to icotinib-alone or chemotherapy plus icotinib. The chemotherapy plus icotinib group showed higher progression-free survival than the icotinib alone group. Our study suggested that the sequential combination of chemotherapy and EGFR-tyrosine kinase inhibitor is feasible for stage IV EGFR-mutated NSCLC patients.