Patients with EGFR mutations benefit from the erlotinib-first regimen because their tumors are very sensitive to the anti-tumor activity of the drug, he explained.
"The take-home message from this study is that in advanced non-small cell lung cancer patients, treatment with erlotinib first should only be applied to patients whose tumor is known to harbor EGFR mutation," said Dr Tsao. "Patients with unknown or negative mutation status should be treated with the standard chemotherapy first."
Commenting on the study which he was not involved in, Dr Tetsuya Mitsudomi from Aichi Cancer Center Hospital in Nagoya, Japan, member of the IASLC Board of Directors, said: "Many previous trials, for instance IPASS, NEJ002, WJTOG3405, OPTIMAL, EUROTAC, have already shown that EGFR mutation is the most reliable predictive marker for EGFR-TKI treatment. The current paper was able to confirm the importance of EGFR mutation testing when considering the use of erlotinib, especially in consideration of the far shorter progression-free survival obtained with erlotinib when the mutation was absent. Consequently, although it was thought that erlotinib is active even in lung cancer patients without EGFR mutation if compared with gefitinib, this study suggests that erlotinib should be avoided when treating patients without EGFR mutation, at least in the first-line setting."
This biomarker analysis was preplanned but actually only 36% of the samples could be anlayzed for EGFR mutation. This relatively low tissue accrual rate is precedented by many clinical trials in which the mutation analysis was performed retrospectively. "Therefore, we also have to consider prospective determination of oncogene mutation when we want to raise this rate such as in NEJ, WJTOG, OPTIMAL and EUROTAC," Dr Mitsudomi added.
"In summary, the TORCH-BIO study adds imprortant evidence to the research f
|Contact: Vanessa Pavinato|
European Society for Medical Oncology