Adjuvant Gefitinib Outperforms Chemotherapy in EGFR-Mutated Lung Cancer Treatment

The lung cancer study ADJUVANT, presented at ASCO 2017, showed that EGFR-targeted Gefitinib provided longer disease-free survival with fewer side effects than standard protective chemotherapy after surgery in EGFR-positive non-small cell lung cancer patients.

In lung cancer , many treatment options exist. When selecting the most appropriate treatment, we consider the tumor’s genetic characteristics as well as disease spread. The most important of these genetic changes in lung cancer is EGFR mutation positivity. If your tumor genetic test is positive for EGFR, drugs targeting this mutation are more effective in treating your cancer. However, drugs targeting EGFR mutations (erlotinib, afatinib, gefitinib, osimertinib) had so far been used only in stage 4 non-small cell lung cancer to prolong survival . Whether they would be effective as protective treatment after surgery in earlier-stage lung cancer was unknown.

Study

Patients with stage 2 and stage 3A EGFR-positive non-small cell lung cancer, totaling 222, were enrolled. After their tumors were removed by lung cancer surgery , patients were divided into two groups while planning adjuvant , or protective, treatment to reduce recurrence risk. One group received gefitinib and the other received standard vinorelbine/cisplatin chemotherapy.

The study’s most important result was median disease-free survival of 28.7 months with gefitinib versus 18 months with chemotherapy. At 3 years, disease-free survival was %34 in the gefitinib group and %27 in the chemotherapy group.

Just as in breast cancer, Her2-targeted treatments were first used in stage 4 disease and then approved sequentially for regionally advanced and early-stage disease, at ASCO 2017 we observed EGFR-targeted treatments following a similar path in lung cancer.

Conclusion

As the Oncotrust team, we found this result extremely valuable. Although long-term survival rates were similar in the chemotherapy and targeted Gefitinib groups, knowing there is a chance for protective treatment with targeted drugs without chemotherapy is very important in lung cancer, a disease with high postoperative recurrence risk even at an early stage. Although targeted drug treatment appears very expensive compared with chemotherapy, we believe it provides an important solution to our helplessness, especially for patients unsuitable for chemotherapy.

- You may be interested in: What is an EGFR mutation? How is EGFR testing performed in lung cancer?