CONVINCE-ing Data For First-Line Icotinib In Chinese Advanced Lung Cancer Patients

Patients with previously untreated epidermal growth factor receptor mutation-positive stage IIIB or IV lung cancer derive a progression-free survival benefit from icotinib over chemotherapy

medwireNews: The CONVINCE trial shows that first-line icotinib treatment is associated with significantly longer progression-free survival (PFS) than chemotherapy with cisplatin plus pemetrexed in Chinese patients with advanced lung adenocarcinoma harbouring epidermal growth factor receptor (EGFR) mutations.

Treatment with the highly selective EFGR tyrosine kinase inhibitor (TKI) also led to fewer side effects, prompting the researchers to comment that “[i]cotinib should therefore be considered as a standard first-line treatment option for this patient population.”

In the phase III trial, PFS by independent review was a median of 11.2 months for the 148 patients with stage IIIB–IV disease positive for the EGFR exon 19 deletion or exon 21 L858R substitution who were randomly assigned to receive oral icotinib at a dose of 125 mg three times daily.

This was significantly longer than the 7.9 months achieved by their 137 counterparts given up to four cycles of intravenous cisplatin 75 mg/m2 plus pemetrexed 500 mg/m2 on the first day of each 21-day cycle, followed by maintenance pemetrexed for those who had not progressed, and equated to a hazard ratio of 0.61.

The PFS benefit conferred by icotinib was maintained across most subgroups stratified by clinical factors such as EGFR mutation type, smoking status and disease stage, reports the team led by Yuankai Shi, from the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, China.

However, there was no significant difference in overall survival between the study arms, which the study authors say is “[s]imilar to previous studies comparing EGFR TKIs with chemotherapy”, and could be due to the effect of icotinib being offset by the post-progression treatments received by the majority of patients in the icotinib (92.5%) and chemotherapy (82.8%) arms.

Of note, icotinib had a “better safety profile” than chemotherapy, they comment, with significantly fewer icotinib- than chemotherapy-treated patients experiencing any-cause and treatment-related grade 3 or 4 adverse events, at rates of 9.5% versus 24.8% and 4.7% versus 23.4%, respectively.

Participants in the icotinib group were also less likely to discontinue treatment as a result of toxicities compared with those in the chemotherapy group, with a respective 2.0% and 17.5% discontinuing the assigned regimen.

Yuankai Shi and colleagues note in the Annals of Oncology that “currently icotinib is only clinically available in China, and requires thrice-daily administration, which might bring inconvenience to patients.”

But they add: “[I]cotinib is associated with less toxicity, economic efficiency, and equivalent efficacy compared with other EGFR TKIs, which is of great importance for fulfilling the growing demand for treatment of advanced [non-small-cell lung cancer] in China.”

Reference

Shi YK, Wang L, Han BH, et al. First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label, randomized study. Ann Oncol; Advance online publication 23 August 2017. doi: https://doi.org/10.1093/annonc/mdx359

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