Evaluating erlotinib plus radiotherapy for stage 3, EGFR-positive non-small cell lung cancer that cannot be surgically removed

This trial was carried to look at the use of erlotinib (Tarceva) with radiotherapy (RT) compared to standard treatment for EGFR-positive non-small cell lung cancer (NSCLC) that cannot be removed surgically. The authors found that erlotinib and RT improved survival without cancer worsening in these patients.

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Treatment for NSCLC is usually chemotherapy, radiotherapy, and surgical removal of tumors. Despite this, NSCLC can be difficult to treat. EGFR mutation is a gene abnormality that causes excess growth of cancer cells. 

Erlotinib is targeted therapy. It targets the EGFR protein on cancer cells, therefore stopping cancer cells grow and divide. Etoposide (Etopophos) and cisplatin (Platinol) are chemotherapy drugs used to kill cancer cells in NSCLC. In patients with NCSLC that cannot be surgically removed, RT combined with chemotherapy such as etoposide and cisplatin (EC) is commonly used. However, the combination of erlotinib and RT has not been compared to EC and RT in these patients.

There were 41 patients with NSCLC that could not be removed. 20 patients received erlotinib and RT (group 1). 21 patients received EC and RT (group 2). The average follow-up period for this trial was 21.3 months in group 1 and 10.6 months in group 2. 

The average survival without cancer worsening was 24.5 months for group 1 compared to 9 months in group 2. The overall response rate was similar between group 1 (70%) and group 2 (61.9%).

After 1 year, 93.75% of group 1 and 85.12% of group 2 were alive. After 2 years, 80.36% of group 1 and 76.61% of group 2 were alive.

The occurrence of side effects was similar in both groups. However, more patients in group 1 (38.9%) needed dose reductions or stopped treatment compared to group 2 (11.1%). 

The authors concluded that erlotinib and RT may increase survival without cancer progression in patients with EGFR-positive NSCLC that cannot be surgically removed. 

More patients in group 2 were lost to follow-up. Therefore, a definite comparison between the 2 treatments cannot be made. Also, the number of patients was very small. Further larger studies are needed.