PMID- 24192511 OWN - NLM STAT- MEDLINE DCOM- 20141001 LR - 20181203 IS - 1872-8332 (Electronic) IS - 0169-5002 (Linking) VI - 83 IP - 1 DP - 2014 Jan TI - A population-based review of the feasibility of platinum-based combination chemotherapy after tyrosine kinase inhibition in EGFR mutation positive non-small cell lung cancer patients with advanced disease. PG - 73-7 LID - S0169-5002(13)00451-0 [pii] LID - 10.1016/j.lungcan.2013.10.007 [doi] AB - INTRODUCTION: The IPASS trial demonstrated superior progression free survival for Asian, light/never smoking, advanced, pulmonary adenocarcinoma patients treated with first-line gefitinib compared to carboplatin/paclitaxel, of which 59% of those tested were epidermal growth factor receptor (EGFR) mutation positive. In IPASS 39% of gefitinib treated patients went on to receive platin based polychemotherapy. We hypothesized that in a population-based setting fewer patients receive second-line platin based chemotherapy than those enrolled in a clinical trial. METHODS: The Iressa Alliance program provided standardized EGFR mutation testing and appropriate access to gefitinib to all patients in British Columbia with advanced, non squamous non small cell lung cancer (NSCLC). We retrospectively analyzed clinical, pathologic data and outcomes for all patients tested in this program between March 2010 and June 2011. RESULTS: A total of 548 patients were referred for testing and 22% of patients were mutation positive. Baseline characteristics of mutation negative and mutation positive; median age 67/65, male 41%/31%, Asian 15%/51%, never smoker 21%/58%, stage IV 80%/91%. Median overall survival was 12 months in mutation negative patients and not yet reached in mutation positive (p<0.0001). In mutation positive patients 5% of patients had a complete response, 46% partial response, 34% stable disease, 6% progressive disease. Twenty percent of patients continued on gefitinib after radiographic progression and clinical stability. Sixty-one gefitinib treated patients progressed at the time of analysis; 10% of patients received further gefitinib only, 38% platinum based doublet, 8% other chemotherapy and 44% no further treatment. Performance status most strongly predicted for delivery of second line chemotherapy. CONCLUSIONS: This North American population based study shows similar efficacy of gefitinib in mutation positive patients compared to the IPASS trial. Contrary to our hypothesis, delivery of second line chemotherapy was feasible in a significant proportion of gefitinib treated patients. CI - Copyright (c) 2013 Elsevier Ireland Ltd. All rights reserved. FAU - Mariano, Caroline AU - Mariano C AD - British Columbia Cancer Agency, Department of Medical Oncology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. Electronic address: cmariano@bccancer.bc.ca. FAU - Bosdet, Ian AU - Bosdet I AD - British Columbia Cancer Agency, Department of Pathology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. FAU - Karsan, Aly AU - Karsan A AD - British Columbia Cancer Agency, Department of Pathology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. FAU - Ionescu, Diana AU - Ionescu D AD - British Columbia Cancer Agency, Department of Pathology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. FAU - Murray, Nevin AU - Murray N AD - British Columbia Cancer Agency, Department of Medical Oncology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. FAU - Laskin, Janessa J AU - Laskin JJ AD - British Columbia Cancer Agency, Department of Medical Oncology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. FAU - Zhai, Yongliang AU - Zhai Y AD - Department of Statistics, University of British Columbia, Canada. FAU - Melosky, Barbara AU - Melosky B AD - British Columbia Cancer Agency, Department of Medical Oncology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. FAU - Sun, Sophie AU - Sun S AD - British Columbia Cancer Agency, Department of Medical Oncology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. FAU - Ho, Cheryl AU - Ho C AD - British Columbia Cancer Agency, Department of Medical Oncology, 600 West 10th Avenue, Vancouver, BC, Canada V5Z 4E6. LA - eng PT - Clinical Trial PT - Journal Article DEP - 20131019 PL - Ireland TA - Lung Cancer JT - Lung cancer (Amsterdam, Netherlands) JID - 8800805 RN - 0 (Platinum Compounds) RN - 0 (Quinazolines) RN - BG3F62OND5 (Carboplatin) RN - EC 2.7.10.1 (EGFR protein, human) RN - EC 2.7.10.1 (ErbB Receptors) RN - P88XT4IS4D (Paclitaxel) RN - S65743JHBS (Gefitinib) SB - IM MH - Aged MH - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use MH - Carboplatin/administration & dosage/adverse effects MH - Carcinoma, Non-Small-Cell Lung/*drug therapy/genetics MH - ErbB Receptors/genetics MH - Feasibility Studies MH - Female MH - Gefitinib MH - Humans MH - Lung Neoplasms/*drug therapy/genetics MH - Male MH - Mutation/genetics MH - Paclitaxel/administration & dosage/adverse effects MH - Platinum Compounds/*therapeutic use MH - Population Groups MH - Quinazolines/administration & dosage/adverse effects OTO - NOTNLM OT - Chemotherapy OT - EGFR OT - Gefitinib OT - Population-based OT - Second-line OT - TKI EDAT- 2013/11/07 06:00 MHDA- 2014/10/02 06:00 CRDT- 2013/11/07 06:00 PHST- 2013/07/12 00:00 [received] PHST- 2013/10/05 00:00 [revised] PHST- 2013/10/08 00:00 [accepted] PHST- 2013/11/07 06:00 [entrez] PHST- 2013/11/07 06:00 [pubmed] PHST- 2014/10/02 06:00 [medline] AID - S0169-5002(13)00451-0 [pii] AID - 10.1016/j.lungcan.2013.10.007 [doi] PST - ppublish SO - Lung Cancer. 2014 Jan;83(1):73-7. doi: 10.1016/j.lungcan.2013.10.007. Epub 2013 Oct 19.