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Clinical outcomes of EGFR-TKIs in advanced squamous cell lung cancer
Jin-Fei Si1,2,3, Jing Xiang1,2,3, Jing-Wen Wei2,3,4
1The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China.
Abstract:
We aimed to explore the treatment efficacy of first-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) for lung squamous cell carcinoma (SCC) patients and identify potential beneficial subgroups of EGFR-mutated lung SCC patients in this study. Between February 1st, 2013 and December 1st, 2021, 657 advanced lung SCC patients were enrolled at Zhejiang Cancer Hospital. Amplification refractory mutation system PCR or next-generation sequencing were used to detect gene abnormality. Clinicopathological features were analyzed by chi-square test and the clinical results of lung SCC patients who received first-generation EGFR-TKI were analyzed by the Kaplan-Meier method. Lung SCC patients harboring EGFR mutation accounted for 11.0% in this study. Of 657 lung SCC patients, the median PFS and OS of 116 patients who received targeted therapy were 3.6 months and 16.2 months, patients treated with targeted therapy had similar OS to patients without targeted therapy (p=0.839). Of 110 lung SCC patients who received first-generation EGFR-TKI, EGFR-mutated patients had long PFS (p=0.000) but similar OS (p=0.472) than patients with EGFR wide type. EGFR-mutated SCC patients who received first-generation EGFR-TKI as a first-line benefit are equal to patients who received first-generation EGFR-TKI as the second line or beyond according to similar PFS (p=0.311) and OS (p=0.721) between them. In addition, there was also no significant difference in PFS (p=0.376) and OS (p=0.205) between patients with exon 19 deletion and L858R point mutation. Lung SCC patients harboring EGFR mutation received first-generation EGFR-TKI had better clinical survival than patients with EGFR wide type.
Insights
First-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) show efficacy in lung squamous cell carcinoma (SCC) patients with EGFR mutations, improving progression-free survival (PFS). However, overall survival (OS) benefits were not significantly different compared to wild-type patients.
Area of Science:
- Oncology
- Medical Genetics
- Pharmacology
Background:
- Lung squamous cell carcinoma (SCC) remains a significant cause of cancer mortality worldwide.
- Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have revolutionized non-small cell lung cancer treatment, but their role in SCC is less defined.
- Identifying specific patient subgroups who benefit from EGFR-TKI therapy is crucial for personalized treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of first-generation EGFR-TKIs in advanced lung SCC patients.
- To identify potential subgroups of EGFR-mutated lung SCC patients who may benefit from this targeted therapy.
- To compare clinical outcomes between EGFR-mutated and EGFR wild-type lung SCC patients receiving first-generation EGFR-TKIs.
Main Methods:
- Retrospective analysis of 657 advanced lung SCC patients treated between February 2013 and December 2021.
- EGFR mutation status determined by Amplification Refractory Mutation System PCR or next-generation sequencing.
- Clinical outcomes, including progression-free survival (PFS) and overall survival (OS), analyzed using Kaplan-Meier method and chi-square tests.
Main Results:
- EGFR mutations were detected in 11.0% of the studied lung SCC patients.
- Patients with EGFR mutations receiving first-generation EGFR-TKIs demonstrated significantly longer PFS (p=0.000) compared to EGFR wild-type patients.
- No significant differences in overall survival (OS) were observed between EGFR-mutated and wild-type patients, regardless of first-line or later-line treatment initiation, or specific mutation type (exon 19 deletion vs. L858R).
Conclusions:
- First-generation EGFR-TKIs offer a significant progression-free survival benefit for EGFR-mutated lung SCC patients.
- While PFS is improved, overall survival benefits for EGFR-mutated lung SCC patients treated with first-generation EGFR-TKIs require further investigation.
- EGFR mutation status is a key factor in predicting response to first-generation EGFR-TKIs in lung SCC, warranting targeted therapy considerations.
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