Is targeted therapy combined with surgery beneficial for patients with NSCLC?

This study aimed to determine whether EGFR-TKIs, in combination with surgery, is beneficial to patients with operable non-small-cell lung cancer (NSCLC). The authors concluded that patients with EGFR-mutation-positive NSCLC who were treated with both surgery and EGFR-TKIs showed improved survival compared to patients who underwent surgery alone.

For lung cancer, the first option of treatment is usually surgery if the tumor is operable. However, the relapse rate is often high due to distant metastasis (cancer that has spread to other parts of the body). It is believed that distant metastasis occurs early in NSCLC. Following surgery, patients can be treated with chemotherapy, but there can be a high level of side effects. Alternative therapies are therefore being investigated.

Mutations (genetic changes) in the epidermal growth factor receptor (EGFR) can lead to cancer cell production. A type of biological therapy known as EGFR-TKIs specifically targets cancer cells with this type of mutation. EGFR-TKI treatment could potentially be beneficial in combination with surgery for patients with operable, EGFR-mutation positive NSCLC.

The authors included 5 separate studies to determine whether EGFR-TKI treatment after surgery is beneficial for patients with NSCLC. These studies compared treatment with EGFR-TKIs after surgery to surgery alone without further treatment. A combined total of 1,019 patients were treated with EGFR-TKIs after surgery (group 1). 941 patients were treated with surgery alone (group 2). Patients were followed for an average of 30.6 to 56 months.

Disease-free survival (time from start of trial to disease relapse) was better in patients in group 1, who had a 37% reduction in risk of relapse compared to patients in group 2.

The authors did the same analysis on only patients with EGFR-positive-mutations. Of these, there were 254 patients in group 1 and 406 patients in group 2. Disease-free survival was better for EGFR-positive patients in group 1, who had a 52% reduction in the risk of relapse. Overall survival (time from start of trial to death from any cause) was also better for patients in group 1, who had a 28% reduced risk of death compared to patients in group 2.

Group 1 patients had a reduction in the rate of disease metastasis from 25.1% to 20.6% after EGFR-TKI treatment.

42% of patients in group 1 experienced serious effects including rash, diarrhea, and breathing difficulties. There were 3 treatment-related deaths.

The authors concluded that EGFR-TKI treatment may be beneficial for patients with operable, EGFR-mutation positive NSCLC. Disease-free survival was improved and the risk of metastasis reduced.

Some of the trials included had only small groups of patients. In some cases, the treatment course was too short for the drug to take effect. Whether or not the side effects from this treatment are comparable or less serious than chemotherapy-related side effects remains unclear.