First-line erlotinib versus gemcitabine/cisplatin in patients with advanced EGFR mutation-positive non-small-cell lung cancer: analyses from the phase III, randomized, open-label, ENSURE study
Menée en Asie (Chine, Malaysie, Philippines) sur 217 patients atteints d'un cancer du poumon non à petites cellules de stade IIIB/IV présentant des mutations du gène EGFR, cet essai randomisé de phase III évalue l'efficacité, du point de vue de la survie sans progression, et la toxicité de l'erlotinib par comparaison avec un traitement combinant gemcitabine et cisplatine
Background : The phase III, randomized, open-label ENSURE study (NCT01342965) evaluated first-line erlotinib versus gemcitabine/cisplatin (GP) in patients from China, Malaysia and the Philippines with epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC). Patients and methods : Patients≥18 years old with histologically/cytologically confirmed stage IIIB/IV EGFR mutation-positive NSCLC and Eastern Cooperative Oncology Group performance status 0–2 were randomized 1:1 to receive erlotinib (oral; 150 mg once-daily until progression/unacceptable toxicity) or GP (G 1250 mg/m2 i.v. day 1 and 8 [3-weekly cycle]; P 75 mg/m2 i.v. day 1, [3-weekly cycle] for up to 4 cycles). Primary endpoint: investigator-assessed progression-free survival (PFS). Other endpoints include objective response rate (ORR), overall survival (OS), and safety. Results : 217 patients were randomized: 110 to erlotinib and 107 to GP. Investigator-assessed median PFS was 11.0 months versus 5.5 months, erlotinib versus GP, respectively (hazard ratio [HR], 0.34, 95% confidence interval [CI], 0.22–0.51; log-rank P<0.0001). Independent Review Committee-assessed median PFS was consistent (HR, 0.42). Median OS was 26.3 versus 25.5 months, erlotinib versus GP, respectively (HR, 0.91, 95% CI, 0.63–1.31; log-rank P=.607). ORR was 62.7% for erlotinib and 33.6% for GP. Treatment-related serious adverse events (AEs) occurred in 2.7% versus 10.6% of erlotinib and GP patients, respectively. The most common grade≥3 AEs were rash (6.4%) with erlotinib, and neutropenia (25.0%), leukopenia (14.4%), and anemia (12.5%) with GP. Conclusion : These analyses demonstrate that first-line erlotinib provides a statistically significant improvement in PFS versus GP in Asian patients with EGFR mutation-positive NSCLC (NCT01342965).