Evaluating the effectiveness of EGFR-TKIs first-line treatment and performance status in older patients with EGFR-mutant NSCLC.

This study evaluated the effectiveness of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) first-line treatment and performance status in older patients with EGFR-mutant non-small-cell lung cancer (NSCLC). The data showed that older patients with EGFR-mutated NSCLC who received EGFR-TKI first-line treatment with a good performance status and fewer metastatic sites had better survival outcomes.

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Genetic mutations (changes) in EGFR can lead to NSCLC. EGFR TKIs have been shown to improve survival outcomes and quality of life for patients with advanced NSCLC. EGFR TKIs, such as gefitinib (Iressa) and erlotinib (Tarceva), are drugs used to block the activity of these receptors. 

Performance status is a measure of how well a person is able to carry on daily activities while living with cancer, It also provides an estimate of what treatments a person may tolerate. Most patients included in clinical trials have a very good performance status. The effectiveness of EGFR-TKIs first-line treatment in relation to performance status in older patients with EGFR-mutant NSCLC is still unclear.

This study involved 205 patients with NSCLC who had genetic mutations in EGFR. All patients received EGFR-TKIs targeted therapy. Patients were divided into 2 groups. Group 1 included 91 patients who had a poor performance status (PS=2-4). Group 2 included 114 patients who had a good performance status (PS=0-1).

Patients in group 1 were on average older than patients in group 2 (79 vs 75 years). 41.8% of the patients in group 1 had brain metastases compared to 25.4% of the patients in group 2. 74.7% of the patients in group 1 were more likely to have other medical conditions compared to 54.4% of the patients in group 2. 74.7% of the patients in group 1 were more likely to be treated with first-generation TKIs compared to 57% of the patients in group 1.

The average overall survival was significantly longer in group 2 (26.7 months) than for patients in group 1 (18.2 months). The average survival without cancer worsening was also significantly longer for group 2 (17.1 months) than for patients in group 1 (12.7 months).

A good performance status, fewer metastatic sites (less than 3), and first-line treatment with afatinib (Giotrif) were associated with longer survival without cancer worsening. A relatively younger age, good performance status, fewer metastatic sites (less than 3), and no brain metastasis at diagnosis were associated with better overall survival.

This study concluded that older patients with EGFR-mutated NSCLC who received EGFR-TKI first-line treatment with a good performance status and fewer metastatic sites had better survival outcomes.

This study was based on medical records. It only included patients from Taiwan, which may not translate to different populations.