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Erlotinib Plus Chemo Doesn't Improve Efficacy in NSCLC

Offers no benefit for never or light former smokers with advanced non-small-cell lung cancer

WEDNESDAY, May 2 (HealthDay News) -- Adding chemotherapy with carboplatin plus paclitaxel to the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor erlotinib does not improve efficacy in the treatment of chemotherapy-naive, never or light former smokers with advanced non-small-cell lung cancer (NSCLC), according to a study published online April 30 in the Journal of Clinical Oncology.

Pasi A. Jänne, M.D., Ph.D., of the Dana-Farber Cancer Institute in Boston, and colleagues randomly allocated chemotherapy-naive, never or light former smokers with advanced NSCLC to continuous erlotinib (81 patients) or erlotinib plus carboplatin and paclitaxel (ECP) (100 participants), for six cycles followed by erlotinib monotherapy.

The researchers found no significant difference in progression-free survival (PFS) between the erlotinib and ECP groups (5.0 and 6.6 months, respectively; P = 0.1988). Of the 91 percent of patients for whom EGFR mutation analysis was available, 40 percent of never smokers and 42 percent of light former smokers exhibited EGFR mutations. Erlotinib- and ECP-treated EGFR-mutant patients had improved response rate, PFS, and overall survival. Patients treated with ECP had significantly higher incidence of grade 3 to 4 hematologic and nonhematologic toxicity.

"Improving PFS of patients with EGFR-mutant NSCLC treated with erlotinib remains a critical therapeutic challenge," the authors write. "Our study suggests that this is unlikely to be achieved by adding chemotherapy to erlotinib."

Several authors disclosed financial ties to pharmaceutical companies, including Genentech, which manufactures erlotinib.

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