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Pemetrexed/Carboplatin/Gefitinib: New Standard of Care for Untreated EGFR-Mutant Lung Cancer?

By: Joseph Fanelli
Posted: Friday, July 26, 2019

The addition pemetrexed/carboplatin chemotherapy to the tyrosine kinase inhibitor gefitinib improved both progression-free and overall survival in patients with untreated EGFR-mutant non–small cell lung cancer (NSCLC)—but also led to increased levels of toxicity—according to results presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 9001). Vanita Noronha, MD, of the Tata Memorial Centre, Mumbai, India, and colleagues concluded that this triple regimen may represent a new standard first-line therapy in for this patient population.

In this phase III randomized trial, the investigators enrolled 350 patients who had been diagnosed with NSCLC that harbored EGFR-sensitizing mutations. Patients were divided into two cohorts: gefitinib alone or gefitinib plus pemetrexed and carboplatin. Of the study patients, 48% were female, 84% had never smoked, 21% had a performance status of 2, and 18% had brain metastases.

For those who were treated with gefitinib alone, the radiologic response rate reached 69%, compared with 81% for those patients who received gefitinib and pemetrexed/carboplatin. More than two-thirds of all patients (234 patients) had events for progression-free survival, with 136 persons in the gefitinib alone group experiencing events compared with 98 in the pemetrexed/carboplatin cohort. Subsequently, patients who received gefitinib with pemetrexed/carboplatin had significantly longer progression-free survival than those treated with gefitinib (16 months vs. 8 months, respectively).

After a median follow-up of 17 months, 120 patients had died, 42 in the triplet-therapy group and 78 in the gefitinib-alone group. Overall survival was also improved in those in the former cohort (not reached vs. 18 months, respectively). Clinically relevant grade 3 and higher toxicities occurred in 51% and 25% of those who received gefitinib plus pemetrexed/carboplatin and gefitinib alone, respectively.

Disclosure: The study authors’ disclosure information may be found at coi.asco.org.



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