J Cancer 2017; 8(18):3682-3688. doi:10.7150/jca.20017

Research Paper

Continuation of Tyrosine Kinase Inhibitor is Associated with Survival Benefit in NSCLC Patients with Exon 19 Deletion after Solitary Progression

Feifei Na1, 2, 5*, Jie Zhang3, 4*, Lei Deng1, 2, 5, Xiaojuan Zhou1, Lin Zhou1, Bingwen Zou1, Min Yu1, Yanying Li1, Jianxin Xue1, Yongmei Liu1✉

1. Department of Thoracic Cancer, Cancer Center, West China Hospital, West China School of Medicine, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, China, 610041;
2. Huaxi Student Society of Oncology Research, West China School of Medicine, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, China, 610041;
3. Department of Medical Oncology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuzhongqu, Chongqing, China, 400016;
4. Department of Medical Oncology, Cancer Center, West China Hospital, West China School of Medicine, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan, China, 610041;
5. Department of Thoracic Cancer, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China School of Medicine, Sichuan University and Collaborative Innovation Center, 37 Guoxue Lane, Chengdu, Sichuan, China, 610041.
* These authors contributed equally

Abstract

Introduction: The benefit and selection criteria of continuing tyrosine kinase inhibitor (TKI) after secondary resistance in non-small cell lung cancers (NSCLCs) with epidermal growth factor receptor (EGFR) mutation remain largely unknown. This study was designed to investigate the role and predictive factors of TKI continuation in patients with solitary progression.

Methods: We retrospectively analyzed NSCLCs treated with first generation of TKI from June 2009 to October 2014 in our cancer center. Number of progressive lesions upon first progression was recorded per RECIST v1.1.

Results: Sixty-one of 144 (42.4%) patients progressed with one lesion. Postprogression TKI use information was available in 58 patients. No brain metastases and stable disease compared to immediate prior scans were associated continued TKI. In the whole cohort, TKI as the first line treatment was found to be associated with longer postprogression survival, but TKI continuation was not. In patients with exon 19 deletion, TKI continuation compared to discontinuation was significantly associated with longer postprogression survival (32.0 months, 95% CI: 20.8 - 43.3 vs. 15.6 months, 95% CI: 7.3 - 23.8, p=0.013). This difference was not observed in L858R mutation. Exon 19 deletion patients had longer time to TKI cessation after progression (13.7 months, 95% CI: 4.5-22.9 vs. 5.6 months in L858R, 95% CI: 0.0-11.9, p = 0.047).

Conclusions: TKI continuation may prolong survival of NSCLCs with exon 19 deletion rather than L858R. Further studies are required to validate this finding.

Keywords: EGFR mutation, exon 19 deletion, L858R, TKI continuation.

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How to cite this article:
Na F, Zhang J, Deng L, Zhou X, Zhou L, Zou B, Yu M, Li Y, Xue J, Liu Y. Continuation of Tyrosine Kinase Inhibitor is Associated with Survival Benefit in NSCLC Patients with Exon 19 Deletion after Solitary Progression. J Cancer 2017; 8(18):3682-3688. doi:10.7150/jca.20017. Available from http://www.jcancer.org/v08p3682.htm