Comparison of first-generation EGFR-TKIs (gefitinib, erlotinib, and icotinib) as adjuvant therapy in resected NSCLC patients with sensitive EGFR mutations
Background: Several randomized controlled trials have suggested that adjuvant epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) were associated with prolonged disease-free survival (DFS) in EGFR-mutated NSCLC patients after radical resection, comparing with chemotherapy or placebo. We aimed to compare the effectiveness of different first-generation EGFR-TKIs as adjuvant treatment in real-world setting. Methods: Early-stage EGFR mutated NSCLC patients who underwent radical resection and treated with first-generation EGFR-TKIs (gefitinib, erlotinib, icotinib) as adjuvant therapy between Feb 2010 and Jan 2019 were retrieved from a prospectively-maintained database in our center. The primary endpoint was DFS in stage II/III (TNM 8th) patients with exploratory endpoint regarding DFS in stage I patients. Sensitivity analyses were based on propensity score matched (PSM) cohorts. Treatment failure patterns among different TKIs were also compared. Results: Of 588 eligible patients, 198 patients (33.7%) received gefitinib, 106 patients (17.9%) received erlotinib, and 284 patients (48.2%) received icotinib. The median DFS of stage II/III patients in the gefitinib, erlotinib and icotinib group were 36.1 months (95% CI, 23.9-49.4), 42.8 months (95% CI, 29.6-97.8), and 32.5 months (95% CI, 23.9-49.4), respectively, with no significant difference (log-rank test P=0.22). There was also no significant difference in DFS among stage I patients receiving different TKIs (P=0.12). PSM adjustments and multivariate analyses adjusting for other confounders revealed similar results. In addition, there were no significant differences in treatment failure pattens in different EGFR-TKI arms, especially in terms of brain metastases (6.1% in gefitinb, 7.5% in erlotinib, 3.9% in icotinib) and bone metastases (8.6% in gefitinb, 9.4% in erlotinib, 7.0% in icotinib). Conclusions: This first and largest real-world study showed that gefitinib, erlotinib, and icotinib demonstrated comparable clinical effectiveness as adjuvant therapy for patients with early-stage EGFR mutated NSCLC.
基金：
China National Science FoundationNational Natural Science Foundation of China (NSFC) [82022048, 81871893]; Key Project of Guangzhou Scientific Research Project [201804020030]; High-Level University Construction Project of Guangzhou Medical University [20182737, 201721007, 201715907, 2017160107]; National Key RD Program [2017YFC0907903, 2017YFC0112704]; Guangdong High Level Hospital Construction "reaching peak" plan
第一作者机构：[1]Guangzhou Med Univ, Affiliated Hosp 1, Dept Thorac Surg & Oncol, Guangzhou, Peoples R China[2]Guangzhou Inst Resp Dis, Guangzhou, Peoples R China[3]China State Key Lab Resp Dis, 151 Yanjiang Rd, Guangzhou 510120, Guangdong, Peoples R China[4]Natl Clin Res Ctr Resp Dis, Guangzhou, Peoples R China
共同第一作者：
通讯作者：
通讯机构：[1]Guangzhou Med Univ, Affiliated Hosp 1, Dept Thorac Surg & Oncol, Guangzhou, Peoples R China[2]Guangzhou Inst Resp Dis, Guangzhou, Peoples R China[3]China State Key Lab Resp Dis, 151 Yanjiang Rd, Guangzhou 510120, Guangdong, Peoples R China[4]Natl Clin Res Ctr Resp Dis, Guangzhou, Peoples R China[10]First Peoples Hosp Zhaoqing, Dept Med Oncol, Zhaoqing, Peoples R China[*1]Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, No. 151, Yanjiang Rd, Guangzhou 510120, China.
推荐引用方式(GB/T 7714)：
He Qihua,Liu Jun,Cai Xiuyu,et al.Comparison of first-generation EGFR-TKIs (gefitinib, erlotinib, and icotinib) as adjuvant therapy in resected NSCLC patients with sensitive EGFR mutations[J].TRANSLATIONAL LUNG CANCER RESEARCH.2021,10(11):4120-+.doi:10.21037/tlcr-21-649.
APA：
He, Qihua,Liu, Jun,Cai, Xiuyu,Li, Caichen,Liang, Hengrui...&Liang, Wenhua.(2021).Comparison of first-generation EGFR-TKIs (gefitinib, erlotinib, and icotinib) as adjuvant therapy in resected NSCLC patients with sensitive EGFR mutations.TRANSLATIONAL LUNG CANCER RESEARCH,10,(11)
MLA：
He, Qihua,et al."Comparison of first-generation EGFR-TKIs (gefitinib, erlotinib, and icotinib) as adjuvant therapy in resected NSCLC patients with sensitive EGFR mutations".TRANSLATIONAL LUNG CANCER RESEARCH 10..11(2021):4120-+
