Evaluating the effectiveness of first-line treatments in the elderly and non-elderly patients with advanced EGFR-mutated NSCLC.

This study evaluated the effectiveness of different first-line treatments in elderly and non-elderly patients with advanced epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). The data showed that osimertinib (Tagrisso) was the best treatment regimen to improve survival without cancer worsening in elderly patients. At the same time, the standard of care plus chemotherapy was the best strategy to improve survival without cancer worsening for younger patients.

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. Standard treatment for advanced NSCLC involves surgical removal of solid tumors, chemotherapy, and targeted therapy.

Genetic mutations (abnormalities) in the EGFR gene can lead to NSCLC. EGFR helps cancer cells grow and spread faster. EGFR tyrosine kinase inhibitors (TKIs), such as gefitinib (Iressa) and erlotinib (Tarceva), are drugs used to block the activity of these proteins. TKIs are a type of targeted therapy that works by stopping the growth of cancer cells. Osimertinib is a newer generation of EGFR-TKI that is approved for treating advanced EGFR-mutant NSCLC. Osimertinib has been shown to improve survival outcomes for these patients.

The standard treatment for elderly (older than 65 years) cancer patients is still under debate. This is mainly because older patients are often excluded from or underrepresented in clinical trials. Therefore, it is important to evaluate the effectiveness of optimal first-line treatments in elderly and non-elderly patients with EGFR-mutant NSCLC.

This study analyzed 12 other studies and involved 3779 patients with advanced NSCLC. All patients had genetic mutations in the EGFR. Patients received one of the 10 different treatments- EGFR-TKIs such as erlotinib, gefitinib, afatinib (Gilotrif), dacomitinib (Vizimpro), and osimertinib, pemetrexed (Alimta)-based chemotherapy, pemetrexed-free chemotherapy, and combination therapy such as erlotinib plus ramucirumab (Cyramza), gefitinib plus apatinib (Aitan), and gefitinib plus pemetrexed-based chemotherapy. Patients were divided into 2 groups. Group 1 included elderly patients (older than 65 years old) and group 2 included non-elderly patients (younger than 65 years old).

Osimertinib had the highest probability of being the best treatment regimen for improving survival without cancer worsening in all the patients (by 42.2%) and in elderly patients by (31.46%). In the non-elderly group, the standard of care (EGFR-TKIs) plus chemotherapy had the highest probability (31.66%) to be the best treatment regimen for improving survival without cancer worsening.

Standard of care (EGFR-TKIs) plus chemotherapy had the highest probability of being the best treatment regimen in terms of overall survival in all patients (64.33%), elderly group (34.45%), or non-elderly group (61.98%).

This study concluded that osimertinib was the best treatment regimen to improve survival without cancer worsening in elderly patients while the standard of care (EGFR-TKIs) plus chemotherapy was the best strategy to improve survival without cancer worsening for non-elderly patients with advanced EGFR-mutant NSCLC. Standard of care (EGFR-TKIs) plus chemotherapy was the best strategy to improve overall survival in both elderly and non-elderly patients with EGFR-mutated NSCLC.

This study analyzed very different studies. This study did not evaluate the effectiveness of the combination therapy of chemotherapy and second or third-generation EGFR-TKIs. This study did not analyze the side effects associated with each strategy for elderly patients.