Comparing EGFR-TKI, Chemotherapy Versus EGFR-TKI Monotherapy as Neoadjuvant Treatment of Stage III-N2 EGFR-Mutant NSCLC

Results of a study that explored the potential benefits of combining first-generation EGFR-TKI with chemotherapy as neoadjuvant treatment for stage III-N2 EGFR-mutant NSCLC were presented at the ESMO Targeted Anticancer Therapies Congress 2024.

The researchers retrospectively reviewed medical records of patients with stage III-N2 EGFR-mutant NSCLC and compared those who received first-generation TKI combined with chemotherapy as neoadjuvant treatment (the observation group) with those who received EGFR-TKI monotherapy (the control group). The records of 53 patients were analyzed, of whom 15 received first-generation EGFR-TKI combined with chemotherapy as neoadjuvant treatment and 38 received EGFR-TKI monotherapy. Median follow-up was 44.12 months.

Results showed the ORR was 50.0% in the combination group and 40.5% in the monotherapy group (P=.495). Major pathologic response was observed in 20.0% and 10.5% of patients in the combination and monotherapy groups, respectively (P=.359). None of the patients in the combination group achieved pathologic complete response (PCR), but three in the monotherapy group did achieve PCR. The researchers also found the two groups did not differ in N2 downstaging rate (P=.459). Median disease-free survival (DFS) was not reached in the combination group but was 23.6 months (95% CI, 8.16-39.02) in the monotherapy group (P=.832). AEs were consistent with those commonly observed with both treatments.

The researchers concluded that combination therapy with first-generation EGFR-TKI and chemotherapy could be considered a neoadjuvant treatment option for patients with EGFR-mutant stage III-N2 NSCLC, exhibiting acceptable toxicity. “However, regarding short-term efficacy, combination therapy did not demonstrate superiority over EGFR-TKI monotherapy. Long-term follow-up is warranted for a more accurate assessment of the DFS and overall survival.”

Source: Xu Y, Ji H, Zhang Y, et al. Combination of EGFR-TKI and chemotherapy versus EGFR-TKI monotherapy as neoadjuvant treatment of stage III-N2 EGFR-mutant non-small cell lung cancer. Abstract 70P. Presented at the ESMO Targeted Anticancer Therapies Congress 2024; February 26-28, 2024; Paris, France.