120P - Is switch maintenance therapy mandatory for EGFR mutated patients initiated on chemotherapy?

Date 17 April 2015
Event ELCC 2015
Session Poster lunch
Topics Anti-Cancer Agents & Biologic Therapy
Non-Small-Cell Lung Cancer, Metastatic
Presenter Rakesh Roy
Citation Annals of Oncology (2015) 26 (suppl_1): 29-44. 10.1093/annonc/mdv050
Authors R. Roy
  • Medical Oncology, Saroj Gupta Cancer Centre & Research Institute, 700063 - Kolkata/IN



The average time required in resource limited setting to get an EGFR Mutation report is approximately 25–30 days for patients with lung cancer. Sometimes due to inadequate sample and poor tissue handling results are unobtained. Symptomatic patients are initiated on Platinum doublets immediately after despatching for EGFR Mutation tests. The average no of cycles given before an early clinical and radiological assessment are 2 at an interval of 3 weeks. Incase of SD or PR patients go on to get 4 additional cycles of chemotherapy or switch to TKI for mutation positive patients.
To find out whether an EGFR Mutated lung cancer patient initiated on chemotherapy and responding well should be put on continued maintenance with same agents or switched to TKI's.


14 patients with EGFR Mutation positive metastatic adenocarcinoma lung were selected over a period of 1 year. All were male patients. EGFR mutation testing (exon 18-21) was done from biopsy sample in a reference laboratory. They were all initiated with Platinum and Pemetrexed doublet and it was decided that patients who maintain SD or PR after 6 cycles - ARM A would receive maintenance with Pemetrexed and ARM B would switch to Gefitinib 250 mg.


Each arm had 7 patients of which 6 patients in ARM A had SD or PR and completed additional 12 cycles of maintenance Pemetrexed over a period of 1 year. 1 patient progressed and was put on Gefitinib. In ARM B 2 patients progressed. The 5 patients who maintained SD or PR they received switch therapy with Gefitinib and successfully completed 1 year therapy. Neither of the arms showed any gross toxicity.


In metastatic Adenocarcinoma lung it is often a reasonable choice to continue with agents to which a patient responds and keep TKI in reserve even though patient is EGFR Mutation positive. Point of research would be to explore drug holidays and restarting therapy.


The author has declared no conflicts of interest.