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

ARTICLE HIGHLIGHTS

Research background

In 2018, 2.1 million new lung cancers and 1.8 million deaths were reported, and non-small cell lung cancers (NSCLCs) represent the greatest number (85%-90%) of malignant lung tumors. In Asians, 51.4% of epidermal growth factor receptor (EGFR)-mutated NSCLC was reported and EGFR-tyrosine kinase inhibitors (TKIs) have proved to be an effective treatment for this population.

Research motivation

Drug resistance always occurs after 10 mo of EGFR-TKIs treatment, and combination therapy could be an alternative to solve this difficulty. However, the most adequate combinational strategy remains controversial.

Research objectives

Some clinical studies have reported that sequential chemotherapy followed by maintenance EGFR-TKIs might be a potential strategy compared with EGFR-TKIs monotherapy. The efficacy and tolerability of icotinib has been demonstrated in many studies. Therefore, this pilot randomized controlled trial (RCT) aims to evaluate the efficacy and safety of combination therapy compared with monotherapy.

Research methods

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

Research results

A statistically significant difference was observed between the icotinib-alone and chemotherapy + icotinib groups regarding median progression-free survival (P = 0.0249). No statistically significant difference was found between two and four cycles of chemotherapy which means that the sequential combination of chemotherapy and EGFR-TKIs is feasible. Sequential chemotherapy followed by maintenance EGFR-TKIs might be a potential strategy for EGFR-mutated NSCLC patients; however, the optimal regimen remains to be determined.

Research conclusions

The sequential combination of chemotherapy and EGFR-TKIs could be a feasible strategy for stage IV EGFR-mutated NSCLC patients. It is suggested that 2-cycle sequential combination chemotherapy could have similar effectiveness to that of 4-cycle sequential combination chemotherapy in these patients.

Research perspectives

Future studies should involve a large population from multiple centers around the world to further validate the efficacy and safety of sequential treatment in EGFR-mutated NSCLC patients.