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https://doi.org/10.1371/journal.pone.0123587
Title: | Impact of smoking and brain metastasis on outcomes of advanced EGFR mutation lung adenocarcinoma patients treated with first line epidermal growth factor receptor tyrosine kinase inhibitors | Authors: | Jain A. Lim C. Gan E.M. Ng D.Z. Ng Q.S. Ang M.K. Takano A. Chan K.S. Tan W.M. Kanesvaran R. Toh C.K. Loo C.M. Hsu A.A.L. Devanand A. Lim C.H. Koong H.N. Koh T. Fong K.W. Yap S.P. Kim S.W. Chowbay B. Oon L. Lim K.H. Lim W.T. Tan E.H. Tan D.S.W. |
Keywords: | afatinib erlotinib gefitinib vasculotropin epidermal growth factor receptor protein kinase inhibitor advanced cancer age aged Article Asia brain metastasis cancer palliative therapy cancer staging cancer survival cohort analysis controlled study correlational study disease association EGFR gene female follow up human lung adenocarcinoma major clinical study male overall survival progression free survival retrospective study sex difference smoking treatment outcome adenocarcinoma adult adverse effects antagonists and inhibitors brain tumor demography disease course disease free survival dna mutational analysis drug effects enzymology genetics Kaplan Meier method Lung Neoplasms middle aged multivariate analysis mutation reflex secondary smoking treatment outcome very elderly Adenocarcinoma Adult Aged Aged, 80 and over Brain Neoplasms Cohort Studies Demography Disease Progression Disease-Free Survival DNA Mutational Analysis Female Humans Kaplan-Meier Estimate Lung Neoplasms Male Middle Aged Multivariate Analysis Mutation Neoplasm Staging Protein Kinase Inhibitors Receptor, Epidermal Growth Factor Reflex Smoking Treatment Outcome |
Issue Date: | 2015 | Publisher: | Public Library of Science | Citation: | Jain A., Lim C., Gan E.M., Ng D.Z., Ng Q.S., Ang M.K., Takano A., Chan K.S., Tan W.M., Kanesvaran R., Toh C.K., Loo C.M., Hsu A.A.L., Devanand A., Lim C.H., Koong H.N., Koh T., Fong K.W., Yap S.P., Kim S.W., Chowbay B., Oon L., Lim K.H., Lim W.T., Tan E.H., Tan D.S.W. (2015). Impact of smoking and brain metastasis on outcomes of advanced EGFR mutation lung adenocarcinoma patients treated with first line epidermal growth factor receptor tyrosine kinase inhibitors. PLoS ONE 10 (5) : e0123587. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0123587 | Abstract: | Objectives This purpose of this study was to examine clinical-pathologic factors - particularly smoking and brain metastases - in EGFR mutation positive (M+) lung adenocarcinoma (ADC) to determine their impact on survival in patients treated with first line EGFR TKI. Methods A retrospective review of EGFR mutation reflex testing experience for all ADC diagnosed at a tertiary Asian cancer centre from January 2009 to April 2013. Amongst this cohort, patients with advanced EGFR M+ ADC treated with first line EGFR TKI were identified to determine factors that influence progression free and overall survival. Results 444/742 (59.8%) ADC reflex tested for EGFR mutations were EGFR M+. Amongst neversmokers (n=468), EGFR M+ were found in 74.5%of females and 76.3% of males, and amongst ever smokers (n=283), in 53.3% of females and 35.6%of males. Exon 20 mutations were found more commonly amongst heavy smokers (> 50 pack years and > 20 pack years, Pearson's chi square p=0.044, and p=0.038 respectively). 211 patients treated with palliative first line TKI had a median PFS and OS of 9.2 and 19.6 months respectively. 26% of patients had brain metastasis at diagnosis. This was significantly detrimental to overall survival (HR 1.85, CI 1.09-3.16, p=0.024) on multivariate analysis. There was no evidence that smoking status had a significant impact on survival. Conclusions The high prevalence of EGFR M+ in our patient population warrants reflex testing regardless of gender and smoking status. Smoking status and dosage did not impact progression free or overall survival in patients treated with first line EGFR TKI. The presence of brain metastasis at diagnosis negatively impacts overall survival. © 2015 Jain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | Source Title: | PLoS ONE | URI: | https://scholarbank.nus.edu.sg/handle/10635/165697 | ISSN: | 19326203 | DOI: | 10.1371/journal.pone.0123587 |
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