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Progression-Free Survival of NSCLC Patients Receiving Low-Dose versus a Standard Dose of EGFR-TKI

摘要


Background: Patients with NSCLC sensitive to tyrosine kinase inhibitors (TKI) targeting epidermal growth factor receptor (EGFR) may use lower doses of TKI for various reasons. The treatment outcome in terms of progression-free survival (PFS) of patients receiving a dose reduction of first-generation EGFR-TKIs has not been reported in a real-world population. Here, we evaluate whether PFS was compromised due to dose titration in patients receiving gefitinib or erlotinib. Methods: A retrospective cohort study was conducted and patients with advanced NSCLC sensitive to EGFR-TKI were recruited. Patients whose dose of TKI was titrated two-thirds or less were assigned to the low-dose (LD) group. The standard-dose (control) group included patients receiving 250 mg of gefitinib or 150 mg of erlotinib daily during the whole course of treatment, and they were matched by sex and age with the LD group. The primary outcome was PFS. The secondary outcome was overall survival (OS). Results: The LD group included 20 patients and the control group had 80 patients. The median PFS was 15.4 months in the LD group and 9.3 months in the control group (HR: 0.45, 95% CI: 0.29-0.71; p=0.0018). The median OS was 31.5 months in the LD group and 31.4 months in the control group (HR: 0.99, 95% CI: 0.49-1.98; p=0.98). In the subgroup of gefitinib treatment, the median PFS was 15.4 months in the LD group and 8.1 months in the control group (HR: 0.35, 95% CI: 0.2-0.63; p=0.0029). Among patients receiving erlotinib, the median PFS was 14.3 months in the LD group and 12.1 months in the control group (HR: 0.67, 95% CI: 0.32-1.38; p=0.2747). Median OS was similar in the LD group and the control in both subgroups of gefitinib or erlotinib treatment. Conclusion: This study found that a lower dose of first-generation EGFR-TKI is a non-inferior treatment strategy for NSCLC patients sensitive to EGFR-TKI. Larger-scale prospective studies would be needed to confirm this finding.

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