Comparative Assessment between Palliative Radiotherapy with Concurrent Erlotinib and Radiotherapy Alone in Advanced and/or Metastatic Non-Small Cell Lung Cancer
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Abstract
Introduction: It was earlier documented that concurrent systemic therapy has a beneficial effect in advanced non-small cell lung cancer (NSCLC) patients when given along with palliative local radiation. But, the data in Indian population is limited. So, we conducted the study to assess the effect of concurrent erlotinib and palliative thoracic radiotherapy as compared to palliative radiotherapy alone in patients with advanced and/or metastatic NSCLC. Material & Methods: Previously untreated patients of advanced and/or metastatic NSCLC, were included in this study, to receive either palliative radiotherapy 30Gy/10fractions with concurrent erlotinib 150mg daily (Group 1) or radiotherapy alone with similar dose-fractionation (Group 2). Symptomatic relief & quality of life (QoL) were assessed using different internationally validated tools. Results: A total of 60-patients were enrolled into the study. After 4-weeks of radiotherapy, patients in group 1 showed better improvement in QoL scoring and had more symptomatic relief than group 2. Nineteen and eleven patients of group 1 and 2 showed partial response. Median survival was 7.4 and 5.1 months in group 1 & 2, respectively. Conclusion: Our study concluded that concurrent erlotinib with palliative thoracic radiotherapy in advanced and/or metastatic NSCLC patients results in increased symptomatic relief & survival as well improvement in QoL.
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3. Garon EB, Hellmann MD, Rizvi NA et al. Five-Year Overall Survival for Patients With Advanced Non‒Small-Cell Lung Cancer Treated With Pembrolizumab: Results From the Phase I KEYNOTE-001 Study. J Clin Oncol. 2019;37(28):2518-2527. doi: 10.1200/JCO.19.00934. Epub 2019 Jun 2. PMID: 31154919; PMCID: PMC6768611.
4. Zappa C, Mousa SA. Non-small cell lung cancer: current treatment and future advances. Transl Lung Cancer Res. 2016;5(3):288-300. doi: 10.21037/tlcr.2016.06.07. PMID: 27413711; PMCID: PMC4931124.
5. Ettinger DS, Wood DE, Aisner DL et al. Non-Small Cell Lung Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(5):497-530. doi: 10.6004/jnccn.2022.0025. PMID: 35545176.
6. Lemjabbar-Alaoui H, Hassan OU, Yang YW et al. Lung cancer: Biology and treatment options. Biochim Biophys Acta. 2015;1856(2):189-210. doi: 10.1016/j.bbcan.2015.08.002. Epub 2015 Aug 19. PMID: 26297204; PMCID: PMC4663145.
7. Dima S, Chen KH, Wang KJ et al. Effect of Comorbidity on Lung Cancer Diagnosis Timing and Mortality: A Nationwide Population-Based Cohort Study in Taiwan. Biomed Res Int. 2018; 2018:1252897. doi: 10.1155/2018/1252897. PMID: 30519567; PMCID: PMC6241217.
8. Zeng J, Rengan R, Chetty IJ et al. Lung Cancer. ln: Haperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady’s principles and practice of radiation oncology. 7th ed. Philadelphia: Wolters Kluwer; 2019. p. 1137-1172.
9. Ferrell B, Koczywas M, Grannis F et al. Palliative care in lung cancer. Surg Clin North Am. 2011;91(2):403-417, ix. doi: 10.1016/j.suc.2010.12.003. PMID: 21419260; PMCID: PMC3655433.
10. Wang Y, Schmid-Bindert G, Zhou C. Erlotinib in the treatment of advanced non-small cell lung cancer: an update for clinicians. Ther Adv Med Oncol. 2012;4(1):19-29. doi: 10.1177/1758834011427927. PMID: 22229045; PMCID: PMC3244201.
11. Wang J, Xia TY, Wang YJ et al. Prospective study of epidermal growth factor receptor tyrosine kinase inhibitors concurrent with individualized radiotherapy for patients with locally advanced or metastatic non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2011;81(3):e59-65. doi: 10.1016/j.ijrobp.2010.12.035. Epub 2011 Feb 23. PMID: 21345607.
12. Swaminath A, Wright JR, Tsakiridis TK et al. A phase ii trial of erlotinib and concurrent palliative thoracic radiation for patients with non–small-cell lung cancer. Clin Lung Can. 2016;17(2):142-149.
13. Martínez E, Martínez M, Rico M et al. Feasibility, tolerability, and efficacy of the concurrent addition of erlotinib to thoracic radiotherapy in locally advanced unresectable non-small-cell lung cancer: a Phase II trial. Onco Targets Ther. 2016; 9:1057-1066. doi: 10.2147/OTT.S89755. PMID: 27042098; PMCID: PMC4780183.
14. Liu R, Wei S, Zhang Q et al. Epidermal growth factor receptor tyrosine kinase inhibitors combined with thoracic radiotherapy or chemoradiotherapy for advanced or metastatic non-small cell lung cancer: A systematic review and meta-analysis of single-arm trials. Medicine (Baltimore). 2019;98(29):e16427. doi: 10.1097/MD.0000000000016427. PMID: 31335695; PMCID: PMC6708798.
15. Bungaro M, Passiglia F, Scagliotti GV. COVID-19 and Lung Cancer: A Comprehensive Overview from Outbreak to Recovery. Biomedicines. 2022;10(4):776. doi: 10.3390/biomedicines10040776. PMID: 35453526; PMCID: PMC9027516.
16. Torniai M, Agostinelli V, Cantini L et al. Management of lung cancer patients during COVID-19 pandemic: dos, don'ts and don't knows. Explor Target Antitumor Ther. 2022;3(3):321-336. doi: 10.37349/etat.2022.00085. Epub 2022 Jun 10. PMID: 36045909; PMCID: PMC9400770.
17. Polanski J, Jankowska-Polanska B, Rosinczuk J et al. Quality of life of patients with lung cancer. Onco Targets Ther. 2016; 9:1023-1028. doi: 10.2147/OTT.S100685. PMID: 27013895; PMCID: PMC4778772.
18. Braun DP, Gupta D, Staren ED. Quality of life assessment as a predictor of survival in non-small cell lung cancer. BMC Cancer. 2011; 11:353-361. https://doi.org/10.1186/1471-2407-11-353
19. Jumeau R, Vilotte F, Durham AD et al. Current landscape of palliative radiotherapy for non-small-cell lung cancer. Transl Lung Cancer Res. 2019; 8(Suppl 2):S192-201. doi: 10.21037/tlcr.2019.08.10. PMID: 31673524; PMCID: PMC6795576.
20. Kumar A, Mukundan H, Bhatnagar S et al. Radiation for Palliation: Role of Palliative Radiotherapy in Alleviating Pain/Symptoms in a Prospective Observational Study at Two Tertiary Care Centers. Indian J Palliat Care. 2019; 25(3):391-397. doi: 10.4103/IJPC.IJPC_35_19. PMID: 31413454; PMCID: PMC6659517.
21. Lewis TS, Kennedy JA, Price GJ et al. Palliative Lung Radiotherapy: Higher Dose Leads to Improved Survival? Clin Oncol (R Coll Radiol). 2020;32(10):674-684. doi: 10.1016/j.clon.2020.05.003. Epub 2020 Jun 26. PMID: 32600918; PMCID: PMC7492742.
22. Nawrocki S, Krzakowski M, Wasilewska-Tesluk E et al. Concurrent chemotherapy and short course radiotherapy in patients with stage IIIA to IIIB non-small cell lung cancer not eligible for radical treatment: results of a randomized phase II study. Journal of Thoracic Oncology. 2010;5(8):1255-1262.
23. Revannasiddaiah S, Joshi SC, Pandey KC et al. The results with the addition of metronomic cyclophosphamide to palliative radiotherapy for the treatment of non-small cell lung carcinoma. Ann Transl Med. 2015;3(20):305. doi: 10.3978/j.issn.2305-5839.2015.11.25. PMID: 26697465; PMCID: PMC4669322.
24. Fu Z, Yang X, Wang W et al. Radiotherapy combined with gefitinib for patients with locally advanced non-small cell lung cancer who are unfit for surgery or concurrent chemoradiotherapy: a phase II clinical trial. Radiat Oncol. 2020 Jun 20;15(1):155. doi: 10.1186/s13014-020-01596-2. PMID: 32563259; PMCID: PMC7305585.
25. Agrawal V, Benjamin KT, Ko EC. Radiotherapy and Immunotherapy Combinations for Lung Cancer. Curr Oncol Rep. 2020;23(1):4. doi: 10.1007/s11912-020-00993-w. PMID: 33215306.
26. Zhang HH, Yuan TZ, Li J et al. Erlotinib: An enhancer of radiation therapy in nasopharyngeal carcinoma. Exp Ther Med. 2013; 6(4):1062-1066. doi: 10.3892/etm.2013.1245. Epub 2013 Aug 2. PMID: 24137317; PMCID: PMC3797307.
27. Chinnaiyan P, Huang S, Vallabhaneni G et al. Mechanisms of enhanced radiation response following epidermal growth factor receptor signaling inhibition by erlotinib (Tarceva). Cancer Res. 2005;65(8):3328-3335. doi: 10.1158/0008-5472.CAN-04-3547. PMID: 15833866.
28. Deng Y, Feng W, Wu J et al. The concentration of erlotinib in the cerebrospinal fluid of patients with brain metastasis from non-small-cell lung cancer. Mol Clin Oncol. 2014;2(1):116-120. doi: 10.3892/mco.2013.190. Epub 2013 Sep 23. PMID: 24649318; PMCID: PMC3915642.
29. Jiwnani S, Penumadu P, Ashok A et al. Lung Cancer Management in Low and Middle-Income Countries. Thorac Surg Clin. 2022 Aug;32(3):383-395. doi: 10.1016/j.thorsurg.2022.04.005. PMID: 35961746.
30. Hotwani C, Agarwal JP, Prabhash K et al. Palliative thoracic radiotherapy in advanced lung cancer: A single institution experience. Indian J Cancer. 2017;54(1):262-266. doi: 10.4103/0019-509X.219587. PMID: 29199702.
2. Blandin Knight S, Crosbie PA, Balata H et al. Progress and prospects of early detection in lung cancer. Open Biol. 2017;7(9):170070. doi: 10.1098/rsob.170070. PMID: 28878044; PMCID: PMC5627048.
3. Garon EB, Hellmann MD, Rizvi NA et al. Five-Year Overall Survival for Patients With Advanced Non‒Small-Cell Lung Cancer Treated With Pembrolizumab: Results From the Phase I KEYNOTE-001 Study. J Clin Oncol. 2019;37(28):2518-2527. doi: 10.1200/JCO.19.00934. Epub 2019 Jun 2. PMID: 31154919; PMCID: PMC6768611.
4. Zappa C, Mousa SA. Non-small cell lung cancer: current treatment and future advances. Transl Lung Cancer Res. 2016;5(3):288-300. doi: 10.21037/tlcr.2016.06.07. PMID: 27413711; PMCID: PMC4931124.
5. Ettinger DS, Wood DE, Aisner DL et al. Non-Small Cell Lung Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2022;20(5):497-530. doi: 10.6004/jnccn.2022.0025. PMID: 35545176.
6. Lemjabbar-Alaoui H, Hassan OU, Yang YW et al. Lung cancer: Biology and treatment options. Biochim Biophys Acta. 2015;1856(2):189-210. doi: 10.1016/j.bbcan.2015.08.002. Epub 2015 Aug 19. PMID: 26297204; PMCID: PMC4663145.
7. Dima S, Chen KH, Wang KJ et al. Effect of Comorbidity on Lung Cancer Diagnosis Timing and Mortality: A Nationwide Population-Based Cohort Study in Taiwan. Biomed Res Int. 2018; 2018:1252897. doi: 10.1155/2018/1252897. PMID: 30519567; PMCID: PMC6241217.
8. Zeng J, Rengan R, Chetty IJ et al. Lung Cancer. ln: Haperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady’s principles and practice of radiation oncology. 7th ed. Philadelphia: Wolters Kluwer; 2019. p. 1137-1172.
9. Ferrell B, Koczywas M, Grannis F et al. Palliative care in lung cancer. Surg Clin North Am. 2011;91(2):403-417, ix. doi: 10.1016/j.suc.2010.12.003. PMID: 21419260; PMCID: PMC3655433.
10. Wang Y, Schmid-Bindert G, Zhou C. Erlotinib in the treatment of advanced non-small cell lung cancer: an update for clinicians. Ther Adv Med Oncol. 2012;4(1):19-29. doi: 10.1177/1758834011427927. PMID: 22229045; PMCID: PMC3244201.
11. Wang J, Xia TY, Wang YJ et al. Prospective study of epidermal growth factor receptor tyrosine kinase inhibitors concurrent with individualized radiotherapy for patients with locally advanced or metastatic non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2011;81(3):e59-65. doi: 10.1016/j.ijrobp.2010.12.035. Epub 2011 Feb 23. PMID: 21345607.
12. Swaminath A, Wright JR, Tsakiridis TK et al. A phase ii trial of erlotinib and concurrent palliative thoracic radiation for patients with non–small-cell lung cancer. Clin Lung Can. 2016;17(2):142-149.
13. Martínez E, Martínez M, Rico M et al. Feasibility, tolerability, and efficacy of the concurrent addition of erlotinib to thoracic radiotherapy in locally advanced unresectable non-small-cell lung cancer: a Phase II trial. Onco Targets Ther. 2016; 9:1057-1066. doi: 10.2147/OTT.S89755. PMID: 27042098; PMCID: PMC4780183.
14. Liu R, Wei S, Zhang Q et al. Epidermal growth factor receptor tyrosine kinase inhibitors combined with thoracic radiotherapy or chemoradiotherapy for advanced or metastatic non-small cell lung cancer: A systematic review and meta-analysis of single-arm trials. Medicine (Baltimore). 2019;98(29):e16427. doi: 10.1097/MD.0000000000016427. PMID: 31335695; PMCID: PMC6708798.
15. Bungaro M, Passiglia F, Scagliotti GV. COVID-19 and Lung Cancer: A Comprehensive Overview from Outbreak to Recovery. Biomedicines. 2022;10(4):776. doi: 10.3390/biomedicines10040776. PMID: 35453526; PMCID: PMC9027516.
16. Torniai M, Agostinelli V, Cantini L et al. Management of lung cancer patients during COVID-19 pandemic: dos, don'ts and don't knows. Explor Target Antitumor Ther. 2022;3(3):321-336. doi: 10.37349/etat.2022.00085. Epub 2022 Jun 10. PMID: 36045909; PMCID: PMC9400770.
17. Polanski J, Jankowska-Polanska B, Rosinczuk J et al. Quality of life of patients with lung cancer. Onco Targets Ther. 2016; 9:1023-1028. doi: 10.2147/OTT.S100685. PMID: 27013895; PMCID: PMC4778772.
18. Braun DP, Gupta D, Staren ED. Quality of life assessment as a predictor of survival in non-small cell lung cancer. BMC Cancer. 2011; 11:353-361. https://doi.org/10.1186/1471-2407-11-353
19. Jumeau R, Vilotte F, Durham AD et al. Current landscape of palliative radiotherapy for non-small-cell lung cancer. Transl Lung Cancer Res. 2019; 8(Suppl 2):S192-201. doi: 10.21037/tlcr.2019.08.10. PMID: 31673524; PMCID: PMC6795576.
20. Kumar A, Mukundan H, Bhatnagar S et al. Radiation for Palliation: Role of Palliative Radiotherapy in Alleviating Pain/Symptoms in a Prospective Observational Study at Two Tertiary Care Centers. Indian J Palliat Care. 2019; 25(3):391-397. doi: 10.4103/IJPC.IJPC_35_19. PMID: 31413454; PMCID: PMC6659517.
21. Lewis TS, Kennedy JA, Price GJ et al. Palliative Lung Radiotherapy: Higher Dose Leads to Improved Survival? Clin Oncol (R Coll Radiol). 2020;32(10):674-684. doi: 10.1016/j.clon.2020.05.003. Epub 2020 Jun 26. PMID: 32600918; PMCID: PMC7492742.
22. Nawrocki S, Krzakowski M, Wasilewska-Tesluk E et al. Concurrent chemotherapy and short course radiotherapy in patients with stage IIIA to IIIB non-small cell lung cancer not eligible for radical treatment: results of a randomized phase II study. Journal of Thoracic Oncology. 2010;5(8):1255-1262.
23. Revannasiddaiah S, Joshi SC, Pandey KC et al. The results with the addition of metronomic cyclophosphamide to palliative radiotherapy for the treatment of non-small cell lung carcinoma. Ann Transl Med. 2015;3(20):305. doi: 10.3978/j.issn.2305-5839.2015.11.25. PMID: 26697465; PMCID: PMC4669322.
24. Fu Z, Yang X, Wang W et al. Radiotherapy combined with gefitinib for patients with locally advanced non-small cell lung cancer who are unfit for surgery or concurrent chemoradiotherapy: a phase II clinical trial. Radiat Oncol. 2020 Jun 20;15(1):155. doi: 10.1186/s13014-020-01596-2. PMID: 32563259; PMCID: PMC7305585.
25. Agrawal V, Benjamin KT, Ko EC. Radiotherapy and Immunotherapy Combinations for Lung Cancer. Curr Oncol Rep. 2020;23(1):4. doi: 10.1007/s11912-020-00993-w. PMID: 33215306.
26. Zhang HH, Yuan TZ, Li J et al. Erlotinib: An enhancer of radiation therapy in nasopharyngeal carcinoma. Exp Ther Med. 2013; 6(4):1062-1066. doi: 10.3892/etm.2013.1245. Epub 2013 Aug 2. PMID: 24137317; PMCID: PMC3797307.
27. Chinnaiyan P, Huang S, Vallabhaneni G et al. Mechanisms of enhanced radiation response following epidermal growth factor receptor signaling inhibition by erlotinib (Tarceva). Cancer Res. 2005;65(8):3328-3335. doi: 10.1158/0008-5472.CAN-04-3547. PMID: 15833866.
28. Deng Y, Feng W, Wu J et al. The concentration of erlotinib in the cerebrospinal fluid of patients with brain metastasis from non-small-cell lung cancer. Mol Clin Oncol. 2014;2(1):116-120. doi: 10.3892/mco.2013.190. Epub 2013 Sep 23. PMID: 24649318; PMCID: PMC3915642.
29. Jiwnani S, Penumadu P, Ashok A et al. Lung Cancer Management in Low and Middle-Income Countries. Thorac Surg Clin. 2022 Aug;32(3):383-395. doi: 10.1016/j.thorsurg.2022.04.005. PMID: 35961746.
30. Hotwani C, Agarwal JP, Prabhash K et al. Palliative thoracic radiotherapy in advanced lung cancer: A single institution experience. Indian J Cancer. 2017;54(1):262-266. doi: 10.4103/0019-509X.219587. PMID: 29199702.
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| Issue | Vol 15 No 3 (2023) | |
| Section | Original Articles | |
| Keywords | ||
| concurrent erlotinib non-small cell lung cancer palliative radiotherapy quality of life | ||
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How to Cite
1.
Sukhija D, Paul D, Chauhan A, Soni A, Kaur P, Redhu J. Comparative Assessment between Palliative Radiotherapy with Concurrent Erlotinib and Radiotherapy Alone in Advanced and/or Metastatic Non-Small Cell Lung Cancer. Basic Clin Cancer Res. 2024;15(3):187-196.
