NEW YORK (Reuters Health) – Results of a meta-analysis confirm that the oral tyrosine kinase inhibitor gefitinib is effective as first-line therapy in patients with advanced non-small-cell lung cancer whose tumors harbor EGFR (epidermal growth factor receptor) mutations.

“Initial gefitinib is associated with a higher ORR (objective response rate) and PFS (progression-free survival) as well as superior toxicity and QoL profiles as compared to chemotherapy,” Dr. Geoffrey Y. Ku, at Johns Hopkins Singapore International Medical Center, and colleagues report in Lung Cancer online May 11.

The authors explain that it became apparent that female Asian lung cancer patients who were never smokers derived particular benefit from tyrosine kinase inhibitor, and activating mutations in the EGFR were subsequently identified in this subset of patients. “On the basis of these observations, four randomized phase III studies have compared first-line gefitinib vs. chemotherapy in East Asian patients with advanced NSCLC.”

For the current study, the researchers performed a meta-analysis of those four studies to quantify the benefits and toxicities of gefitinib compared with chemotherapy.

Overall, 1860 patients were randomized to gefitinib or chemotherapy. All the participants had known or clinically suspected EGFR mutations.

Fatigue, nausea and myelosuppression were significantly more common in the patients given chemo than those receiving gefitinib, according to the report. On the other hand, rash and diarrhea were more common in the gefitinib arms.

Quality of life scores on three instruments were significantly better in the gefitinib group than the placebo group (odds ratios 1.34, 1.78 and 1.13), the team found.

Progression free-survival was better with gefitinib than chemotherapy (hazard ratio 0.45), but overall survival was not significantly different between the two groups, Dr. Ku and colleagues report.

The lack of overall survival benefit “suggests that patients with an acceptable performance status can be treated with either upfront chemotherapy or gefitinib,” they conclude. However, they add,

“It does remain likely that many patients and their physicians will choose upfront gefitinib because of its superior tolerability.”

Reference:
Gefitinib vs. chemotherapy as first-line therapy in advanced non-small cell lung cancer: Meta-analysis of phase III trials
Lung Cancer 2011.