First-Line Pemetrexed Plus Cisplatin Followed by Gefitinib Maintenance Therapy Versus Gefitinib Monotherapy in East Asian Never-Smoker Patients with Locally Advanced or Metastatic Nonsquamous Non-Small-cell Lung Cancer: Quality of Life Results from a Randomized Phase III Trial
Journal
Clinical Lung Cancer
Journal Volume
17
Journal Issue
2
Pages
150-160
Date Issued
2016
Author(s)
Abstract
Background The efficacy results from an open-label, randomized, multicenter study found no significant difference in progression-free survival between pemetrexed plus cisplatin followed by maintenance gefitinib (PC/G) and gefitinib monotherapy (G) in patients with advanced nonsquamous non-small-cell lung cancer (NSCLC) and unknown epidermal growth factor receptor (EGFR) mutation status (hazard ratio favored PC/G). The present report describes the quality of life (QoL) results from that trial. Patients and Methods Chemotherapy-naive, East Asian, light ex-smokers or never-smokers with advanced nonsquamous NSCLC and unknown EGFR mutation status (n = 236) were randomly assigned (1:1) to PC/G or G. EGFR mutation status was subsequently determined for 74 patients. The symptoms and QoL were assessed using the Lung Cancer Symptom Scale (LCSS). The time to worsening of symptoms (TWS) was analyzed using the Kaplan-Meier method. Results In the overall population, the TWS was generally longer in the G group (n = 109) than in the PC/G group (n = 109) for the LCSS symptoms classified as treatment-related (loss of appetite, fatigue) and tumor-related (cough, dyspnea, hemoptysis, pain). In the subgroup of patients with wild-type EGFR, the TWS was generally longer in the PC/G group (n = 13) than in the G group (n = 8) for the tumor-related LCSS symptoms. Conclusion In this study population clinically selected to respond to gefitinib, the LCSS scores were more favorable in the G group than in the PC/G group. Patients with wild-type EGFR tended to show greater improvement in tumor-related LCSS symptoms with chemotherapy than with gefitinib alone. These LCSS outcomes provide further evidence that patients with wild-type EGFR might not benefit from first-line treatment of advanced NSCLC with gefitinib. ? 2016 Eli Lilly and Company.
Subjects
Adenocarcinoma; Chemotherapy; Epidermal growth factor receptor tyrosine kinase inhibitor; Patient-reported outcomes; Phase III
SDGs
Other Subjects
cisplatin; epidermal growth factor receptor; gefitinib; pemetrexed; antineoplastic agent; cisplatin; EGFR protein, human; epidermal growth factor receptor; gefitinib; pemetrexed; quinazoline derivative; adult; advanced cancer; advanced nonsquamous non small cell lung cancer; advanced nonsquamous non small cell lung cancer; aged; Article; cancer combination chemotherapy; cancer patient; comparative effectiveness; controlled study; coughing; dyspnea; East Asian; fatigue; female; gene mutation; hemoptysis; human; loss of appetite; major clinical study; male; multicenter study; multiple cycle treatment; non small cell lung cancer; pain; quality of life; randomized controlled trial; adenocarcinoma; antagonists and inhibitors; Asian continental ancestry group; cancer staging; Carcinoma, Non-Small-Cell Lung; clinical trial; genetics; induction chemotherapy; maintenance chemotherapy; metastasis; middle aged; mortality; mutation; pathology; phase 3 clinical trial; smoking; survival analysis; treatment outcome; very elderly; young adult; Adenocarcinoma; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Asian Continental Ancestry Group; Carcinoma, Non-Small-Cell Lung; Cisplatin; Female; Humans; Induction Chemotherapy; Maintenance Chemotherapy; Male; Middle Aged; Mutation; Neoplasm Metastasis; Neoplasm Staging; Pemetrexed; Quality of Life; Quinazolines; Receptor, Epidermal Growth Factor; Smoking; Survival Analysis; Treatment Outcome; Young Adult
Publisher
Elsevier Inc.
Type
journal article