Comparative effectiveness of concurrent chemoradiotherapy versus EGFR‐tyrosine kinase inhibitors for the treatment of clinical stage IIIb lung adenocarcinoma patients with mutant <i>EGFR</i>

Hsia, Te‐Chun; Liang, Ji An; Li, Chia Chin; Chien, Chun-Ru

doi:10.1111/1759-7714.12847

Cited by 24 publications

(22 citation statements)

References 35 publications

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“…A retrospective study assessed whether EGFR TKI (n=177) could substitute the cCT-RT (n=22) in stage III EGFR -mutant NSCLC patients. The study did not find differences in OS (HR 0.71, 95% CI: 0.34–1.47) or lung cancer-specific survival (HR 0.65, 95% CI: 0.31–1.35), yielding a 5-year OS of 30% and 25%, respectively ( 33 ). The limited number of patients and the retrospective nature of this analysis do not lead to obtain firm conclusions whether EGFR TKI alone may be the preferred treatment option instead of the cCT-RT in EGFR -mutant unresectable stage III NSCLC.…”

Section: Personalized Treatment In Locally-advanced Diseasementioning

confidence: 99%

Targeted therapies for unresectable stage III non-small cell lung cancer

Remón¹,

Hendriks²

2021

Mediastinum

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Until recently, the standard treatment in unresectable stage III non-small cell lung cancer was concurrent chemoradiotherapy, but often with dismal outcome. The introduction of consolidation treatment with immune checkpoint inhibitors has shifted the treatment landscape and prognosis of these patients. However, patients whose tumors harbors an epidermal growth factor receptor (EGFR) mutation derived less benefit, with an increased risk of immune-related adverse events. Moreover, current data suggested that patients with oncogenic addicted tumors, mainly EGFR -positive tumors, and also anaplastic lymphoma kinase ( ALK )-positive have poorer progression free survival after chemoradiotherapy. Indeed, these tumors have also inferior distant control compared with those who have wild-type disease, especially in the central nervous system, highlighting the need for assessing the role of targeted therapies in this patient population. It is speculated that outcome could probably increase with a consolidation treatment strategy including an EGFR tyrosine kinase inhibitor. However, a personalized treatment approach is not considered standard of care in this setting due to lack of robust evidence, as the majority of trials were performed in unselected patients, number of patients is limited and the majority of these studies were underpowered. In this review we summarize the role of tyrosine kinase inhibitors in unresectable stage III NSCLC, specifically focusing on EGFR -mutant tumors.

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Section: Personalized Treatment In Locally-advanced Diseasementioning

confidence: 99%

Targeted therapies for unresectable stage III non-small cell lung cancer

Remón¹,

Hendriks²

2021

Mediastinum

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“…At present, the majority of LUAD patients are diagnosed in the advanced stages and cannot be treated with surgery due to the presence of distant metastasis [ 35 ]. Although chemoradiotherapy can improve symptoms, the adverse reactions are significant [ 36 ]. Therefore, attempts at improving the survival rate of patients have become the main purpose of LUAD treatment.…”

Section: Discussionmentioning

confidence: 99%

Identification of KIF4A and its effect on the progression of lung adenocarcinoma based on the bioinformatics analysis

Song

Tang

2021

Bioscience Reports

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Background: Lung adenocarcinoma (LUAD) is the most frequent histological type of lung cancer, and its incidence has displayed an upward trend in recent years. Nevertheless, little is known regarding effective biomarkers for LUAD. Methods: The robust rank aggregation method was used to mine differentially expressed genes (DEGs) from the gene expression omnibus (GEO) datasets. The Search Tool for the Retrieval of Interacting Genes (STRING) database was used to extract hub genes from the protein–protein interaction (PPI) network. The expression of the hub genes was validated using expression profiles from TCGA and Oncomine databases and was verified by real-time quantitative PCR (qRT-PCR). The module and survival analyses of the hub genes were determined using Cytoscape and Kaplan–Meier curves. The function of KIF4A as a hub gene was investigated in LUAD cell lines. Results: The PPI analysis identified seven DEGs including BIRC5, DLGAP5, CENPF, KIF4A, TOP2A, AURKA, and CCNA2, which were significantly upregulated in Oncomine and TCGA LUAD datasets, and were verified by qRT-PCR in our clinical samples. We determined the overall and disease-free survival analysis of the seven hub genes using GEPIA. We further found that CENPF, DLGAP5, and KIF4A expressions were positively correlated with clinical stage. In LUAD cell lines, proliferation and migration were inhibited and apoptosis was promoted by knocking down KIF4A expression. Conclusion: We have identified new DEGs and functional pathways involved in LUAD. KIF4A, as a hub gene, promoted the progression of LUAD and might represent a potential therapeutic target for molecular cancer therapy.

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“…2,3 In addition, the optimal treatment is less clear for a subset of patients with NSCLC with mutant epidermal growth factor receptor (EGFR), as reported in our previous first nonrandomized population-based study utilizing TCR. 24 Therefore, we did an additional SA for SCLC (SA-2), NSCLC with wild-type EGFR (SA-3) or NSCLC with mutant EGFR (SA-4). In SA-5, we included three additional potential covariates addressed by reviewers during revision to examine the robustness of our findings.…”

Section: Statistical and Subgroup Analysesmentioning

confidence: 99%

Effectiveness of image‐guided radiotherapy for locally advanced lung cancer patients treated with definitive concurrent chemoradiotherapy

Liang

Hsia

et al. 2020

Thoracic Cancer

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Background Image‐guided radiotherapy (IGRT) is an advanced radiotherapy technique to improve the precision and accuracy of treatment delivery. A recent randomized controlled trial (RCT) for prostate cancer patients treated with radiotherapy via either IGRT or routine care reported statistically significantly worse overall survival (OS) for those patients treated with IGRT. This raised the concern regarding the effectiveness of IGRT in definitive concurrent chemoradiotherapy (dCCRT) for locally advanced lung cancer (LALC). Methods Eligible LALC patients diagnosed between 2011 and 2016 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and other outcomes were compared between IGRT and non‐IGRT. We also evaluated OS in various subgroups. Results Our primary analysis consisted of 797 patients in whom covariates were well balanced after PS weighing. The HR for death when IGRT was compared with non‐IGRT was 0.96 (95% confidence interval 0.79–1.15, P = 0.65). There were also no significant differences for most of the other outcomes or subgroup analyses. Conclusions In this updated nonrandomized study, we found that OS of LALC patients treated with dCCRT was not statistically different between those treated with IGRT versus non‐IGRT. The results should be interpreted with caution given the nonrandomized design. Studies regarding toxicity, local control, or designed as RCT are needed to clarify the role of IGRT. Key points Significant findings of the study The OS of LALC patients treated with dCCRT was not statistically different between those treated with IGRT versus those without IGRT, although the observed HR for death was less than unity (ie, in favor of IGRT). What this study adds In this updated nonrandomized study using real world data with additional potential confounders, our study provided a reasonable tentative evidence in the lack of RCT as suggested in the literature.

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Comparative effectiveness of concurrent chemoradiotherapy versus EGFR‐tyrosine kinase inhibitors for the treatment of clinical stage IIIb lung adenocarcinoma patients with mutant EGFR

Cited by 24 publications

References 35 publications

Targeted therapies for unresectable stage III non-small cell lung cancer

Targeted therapies for unresectable stage III non-small cell lung cancer

Identification of KIF4A and its effect on the progression of lung adenocarcinoma based on the bioinformatics analysis

Effectiveness of image‐guided radiotherapy for locally advanced lung cancer patients treated with definitive concurrent chemoradiotherapy

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