Effectiveness and Safety of EGFR-TKI Rechallenge Treatment in Elderly Patients with Advanced Non-Small-Cell Lung Cancer Harboring Drug-Sensitive EGFR Mutations

• Main Authors: Yutaka Yamada, Hisao Imai, Tomohide Sugiyama, Hiroyuki Minemura, Kenya Kanazawa, Takashi Kasai, Koichi Minato, Kyoichi Kaira, Takayuki Kaburagi
• Format: Article
• Language: English
• Published: MDPI AG 2021-09-01
• Series: Medicina
• Subjects: epidermal growth factor receptor; advanced non-small-cell lung cancer; elderly patients; re-administration; tyrosine kinase inhibitor; EGFR-TKI
• Online Access: https://www.mdpi.com/1648-9144/57/9/929
• ISSN: 1010-660X; 1648-9144

<i>Background and Objectives</i>: Epidermal growth factor receptor–tyrosine kinase inhibitors (EGFR-TKIs) are effective first-line chemotherapeutic agents for patients with advanced non-small-cell lung cancer (NSCLC) harboring drug-sensitive <i>EGFR</i> mutations. However, the effectiveness of EGFR-TKI rechallenge after first-line EGFR-TKI treatment is not sufficient in elderly patients (over 75 years of age) harboring drug-sensitive <i>EGFR</i> mutations. Therefore, we investigated the effectiveness and safety of EGFR-TKI rechallenge after first-line EGFR-TKI treatment in elderly patients with advanced NSCLC harboring drug-sensitive <i>EGFR</i> mutations. <i>Materials and Methods</i>: Between April 2008 and December 2015, we analyzed 78 elderly patients with advanced NSCLC harboring drug-sensitive <i>EGFR</i> mutations with first-line EGFR-TKI treatment at four Japanese institutions. We retrospectively evaluated the clinical effectiveness and safety profiles of EGFR-TKI rechallenge after first-line EGFR-TKI treatment in elderly patients with advanced NSCLC harboring drug-sensitive <i>EGFR</i> mutations (exon 19 deletion/exon 21 L858R mutation). <i>Results</i>: Twenty-two patients in the cohort were rechallenged with EGFR-TKI. The median age was 79.5 years (range 75–87 years). Despite the fact that it was a retrospective analysis, even with EGFR-TKI rechallenge treatment the response rate was 23%, progression-free survival was 5.3 months, and overall survival was 14.4 months. Common adverse events included rash acneiform, paronychia, diarrhea, and anorexia. There were no treatment-related deaths. Due to the occurrence of adverse events of grade 2 or more, dose reduction was performed in 15 (68.2%) of 22 cases. <i>Conclusions</i>: EGFR-TKI rechallenge treatment after first-line EGFR-TKI treatment in elderly patients with advanced NSCLC harboring drug-sensitive <i>EGFR</i> mutations was one of the limited, safe and effective treatment options for elderly <i>EGFR</i>-positive lung cancer patients.