Abstract 70P
Background
This study explored the potential benefits of combining first-generation EGFR-TKI with chemotherapy as a neoadjuvant treatment of stage Ⅲ-N2 EGFR-mutant NSCLC patients.
Methods
The medical records of patients with Ⅲ-N2 EGFR-mutant NSCLC who received neoadjuvant therapy with EGFR-TKI at Shanghai Chest Hospital from October 2011 to October 2022 were retrospectively reviewed. Patients with stage III-N2 EGFR-mutant NSCLC who received first-generation TKI combined with chemotherapy as neoadjuvant treatment were included in the observation group, and those who received EGFR-TKI monotherapy were included in the control group.
Results
A total of 74631 EGFR-mutant NSCLC patients were screened, and 60 patients were included, 7 of whom did not undergo surgery after neoadjuvant targeted therapy. Of the remaining 53 patients, 15 received first-generation EGFR-TKI combined with chemotherapy as neoadjuvant treatment, and 38 received EGFR-TKI monotherapy. The median follow-up time was 44.12 months. The ORR was 50.0% (9/18) in the combination group and 40.5% (17/42) in the monotherapy group (p =0.495). MPR was observed in 20.0% (3/15) and 10.5% (4/38) of patients in the combination and monotherapy groups, respectively (p =0.359). No patients achieved PCR in the combination group, while three attained PCR in the monotherapy group. The two groups did not differ in N2 downstaging rate (p =0.459). The median DFS was not reached in the combination group, while it was 23.6 months (95% CI: 8.16-39.02) in the monotherapy group (p = 0.832). Adverse events observed were consistent with those commonly associated with the two treatments.
Conclusions
Combination therapy with first-generation EGFR-TKI and chemotherapy could be considered a neoadjuvant treatment option for NSCLC patients of EGFR-mutant stage III-N2, exhibiting acceptable toxicity. However, regarding short-term efficacy, combination therapy did not demonstrate superiority over EGFR-TKI monotherapy. Long-term follow-up is warranted for a more accurate assessment of the DFS and OS.
Clinical trial identification
Ethical Committee of Shanghai Chest Hospital approval number: IS23024.
Editorial acknowledgement
Legal entity responsible for the study
Shanghai Chest Hospital.
Funding
Sponsored by the Science and Technology Innovation Program of Shanghai (20Y11913800) and Beijing Xisike Clinical Oncology Research Foundation (Y-2019AZQN-1037).
Disclosure
All authors have declared no conflicts of interest.