Elizabeth Dudnik1, Ryan B Natale2 and Ronald B Natale3*
1Division of Oncology, Davidoff Cancer Center, Rabin Medical Center, Israel
2Division of Oncology, New York Presbyterian Brooklyn Hospital, USA
3Division of Oncology, Cedars Sinai Medical Center, USA
Nine major randomized clinical trials of 1st or 2nd generation Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs) vs. platinum-based chemotherapy in patients with newly diagnosed advanced EGFR-mutated lung cancer established EGFR-TKIs as the 1st line standard of care. As detailed in Table 1 below, EGFR-TKIs demonstrated superiority over chemotherapy with respect to Overall Response Rates (ORR) of 56%-85% vs. 15%-47% and median Progression Free Survivals (PFS) of 8.0-13.7 months vs. 5.2-6.9 months, respectively. Despite the superiority of EGFR-TKIs over chemotherapy as initial therapy, treatment cross-over in both arms of the studies resulted in nearly equivalent overall survival strongly suggesting independent and non-cross resistant mechanisms of action between TKIs and chemotherapy [1-11]. Since additive to supra-additive effects can sometimes be achieved with the concurrent use of non-cross resistant treatments, we hypothesized that the concurrent use of EGFR-TKIs and chemotherapy may be superior to their sequential use.
Dudnik E, Natale RB, Natale RB. Longterm Follow-Up on Patients with EGFR-Mutated Lung Cancer Treated with an EGFR-TKI and Concurrent Chemotherapy and Literature Review: Is there a Tail on the Curve? J Cancer Clin. 2018; 1(2): 1006.