The role of the Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors as Therapy for Advanced, Metastatic and Recurrent Non-Small Cell Lung Cancer: A Canadian National Consensus Statement

摘要

Purpose: To provide consensus recommendations on the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in patients with advanced or metastatic non-small cell lung cancer (NSCLC). ? ? Methods: Phase II trials, randomized phase III trials, and meta-analyses, were identified for inclusion through a systematic literature search. ? Results: ? 46 trials were included. There is clear evidence that EGFR-TKIs should not be administered concurrently with platinum-based chemotherapy as first-line therapy of advanced or metastatic NSCLC. There is currently insufficient evidence to recommend single agent EGFR-TKIs as first-line therapy in either unselected populations, or populations selected on the basis of molecular or clinical characteristics. Following failure of platinum-based chemotherapy t he evidence suggests that second-line EGFR-TKIs or second-line chemotherapy result in similar survival. Quality of life and symptom improvement for patients treated with an EGFR-TKI appear better than that of patients treated with second-line docetaxel. While sequence of therapy may not appear to be important, if survival is the outcome of interest, the goal should be to optimize the number of patients receiving three lines of therapy. Based on available data, molecular markers and clinical characteristics do not appear to be predictive of a differential survival benefit from an EGFR-TKI and therefore should not be used to select patients for EGFR-TKI therapy. ? Conclusion: ? EGFR-TKIs represent an additional therapy in the treatment of advanced or metastatic NSCLC. The results of ongoing clinical trials may define the optimal role of these agents and the effectiveness of combinations of these agents with other targeted agents.