The dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer

Background: Adjuvant platinum-based chemotherapy is standard of care for patients with resected stage IIA/B or IIIA NSCLC. Overall survival is suboptimal due to the high metastatic potential of early-stage NSCLC and there is substantial clinical need for additional efficacious adjuvant treatment opt...

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Autores principales:	Barbara Melosky, Parneet Cheema, Rosalyn A. Juergens, Natasha B. Leighl, Geoffrey Liu, Paul Wheatley-Price, Adrian Sacher, Stephanie Snow, Ming-Sound Tsao, Deanna McLeod, Quincy Chu
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/b7c460474e584b6ca7677d4ff0d6ecf3
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spelling	oai:doaj.org-article:b7c460474e584b6ca7677d4ff0d6ecf32021-11-16T23:33:19ZThe dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer1758-835910.1177/17588359211056306https://doaj.org/article/b7c460474e584b6ca7677d4ff0d6ecf32021-11-01T00:00:00Zhttps://doi.org/10.1177/17588359211056306https://doaj.org/toc/1758-8359Background: Adjuvant platinum-based chemotherapy is standard of care for patients with resected stage IIA/B or IIIA NSCLC. Overall survival is suboptimal due to the high metastatic potential of early-stage NSCLC and there is substantial clinical need for additional efficacious adjuvant treatment options. Methods: PubMed (all time to 4 February 2021) and related conference databases were searched using the key search terms ‘NSCLC’ AND ‘Adjuvant’ AND ‘EGFR inhibitor’ OR respective aliases. Results: The literature search identified five adjuvant phase III trials of EGFR inhibitors in early NSCLC. The earlier BR19 and RADIANT trials failed to demonstrate statistically significant improvements in either OS or DFS for gefitinib and erlotinib, respectively, compared with placebo in patients with EGFR mutation-unselected NSCLC. Three subsequent phase III trials, ADAURA, CTONG1104, and IMPACT, were conducted in EGFR-mutant NSCLC. IMPACT showed no statistically significant DFS benefit for adjuvant gefitinib, and although CTONG1104 did report improved DFS for gefitinib (HR = 0.56, p = 0.001), this benefit was not enduring, resulting in comparable 5-year DFS rates. Statistically significant and clinically meaningful DFS benefits were observed in ADAURA for osimertinib compared with placebo in patients with stage IB-IIIA and II-IIIA disease (7th Edition Staging), and these benefits, coupled with a meaningful improvement in 2-year CNS DFS and favorable HRQoL, make osimertinib an important new treatment option for the adjuvant treatment of EGFR exon 19 deletion or exon 21 L858R-mutated stage II-IIIA NSCLC (UICC/AJCC 8th Edition Staging), with final mature OS data eagerly awaited. Conclusion: Adjuvant osimertinib used alone or following platinum-based chemotherapy is now recommended in patients with stage II-IIIA EGFR-mutated NSCLC.Barbara MeloskyParneet CheemaRosalyn A. JuergensNatasha B. LeighlGeoffrey LiuPaul Wheatley-PriceAdrian SacherStephanie SnowMing-Sound TsaoDeanna McLeodQuincy ChuSAGE PublishingarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENTherapeutic Advances in Medical Oncology, Vol 13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Barbara Melosky Parneet Cheema Rosalyn A. Juergens Natasha B. Leighl Geoffrey Liu Paul Wheatley-Price Adrian Sacher Stephanie Snow Ming-Sound Tsao Deanna McLeod Quincy Chu The dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer
description	Background: Adjuvant platinum-based chemotherapy is standard of care for patients with resected stage IIA/B or IIIA NSCLC. Overall survival is suboptimal due to the high metastatic potential of early-stage NSCLC and there is substantial clinical need for additional efficacious adjuvant treatment options. Methods: PubMed (all time to 4 February 2021) and related conference databases were searched using the key search terms ‘NSCLC’ AND ‘Adjuvant’ AND ‘EGFR inhibitor’ OR respective aliases. Results: The literature search identified five adjuvant phase III trials of EGFR inhibitors in early NSCLC. The earlier BR19 and RADIANT trials failed to demonstrate statistically significant improvements in either OS or DFS for gefitinib and erlotinib, respectively, compared with placebo in patients with EGFR mutation-unselected NSCLC. Three subsequent phase III trials, ADAURA, CTONG1104, and IMPACT, were conducted in EGFR-mutant NSCLC. IMPACT showed no statistically significant DFS benefit for adjuvant gefitinib, and although CTONG1104 did report improved DFS for gefitinib (HR = 0.56, p = 0.001), this benefit was not enduring, resulting in comparable 5-year DFS rates. Statistically significant and clinically meaningful DFS benefits were observed in ADAURA for osimertinib compared with placebo in patients with stage IB-IIIA and II-IIIA disease (7th Edition Staging), and these benefits, coupled with a meaningful improvement in 2-year CNS DFS and favorable HRQoL, make osimertinib an important new treatment option for the adjuvant treatment of EGFR exon 19 deletion or exon 21 L858R-mutated stage II-IIIA NSCLC (UICC/AJCC 8th Edition Staging), with final mature OS data eagerly awaited. Conclusion: Adjuvant osimertinib used alone or following platinum-based chemotherapy is now recommended in patients with stage II-IIIA EGFR-mutated NSCLC.
format	article
author	Barbara Melosky Parneet Cheema Rosalyn A. Juergens Natasha B. Leighl Geoffrey Liu Paul Wheatley-Price Adrian Sacher Stephanie Snow Ming-Sound Tsao Deanna McLeod Quincy Chu
author_facet	Barbara Melosky Parneet Cheema Rosalyn A. Juergens Natasha B. Leighl Geoffrey Liu Paul Wheatley-Price Adrian Sacher Stephanie Snow Ming-Sound Tsao Deanna McLeod Quincy Chu
author_sort	Barbara Melosky
title	The dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer
title_short	The dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer
title_full	The dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer
title_fullStr	The dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer
title_full_unstemmed	The dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer
title_sort	dawn of a new era, adjuvant egfr inhibition in resected non-small cell lung cancer
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/b7c460474e584b6ca7677d4ff0d6ecf3
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The dawn of a new era, adjuvant EGFR inhibition in resected non-small cell lung cancer

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