Adjuvant Erlotinib in EGFR-Mutated NSCLC

Conference Correspondent - ASCO 2014 - Lung Cancer

Two presentations at ASCO 2014 examined the value of postoperative adjuvant erlotinib in patients with completely resected Stage IA/B-IIIA NSCLC harboring a tyrosine kinase inhibitor–sensitizing EGFR mutation. In the RADIANT trial (Shepherd FA, et al. ASCO 2014. Abstract 7513), 161 patients with Stage IB-IIIA EGFR+ NSCLC were randomized to receive erlotinib or placebo with or without adjuvant chemotherapy. Patients receiving erlotinib had a longer disease-free survival (DFS) than those administered placebo (46.4 vs 28.5 months; P = .039). There were more brain relapses in the erlotinib group (40% vs 13% in the placebo group), but fewer bone relapses (14% vs 29% with placebo). There were no significant differences in overall survival (OS) between the 2 groups. A similar study—the SELECT trial—examined the efficacy of erlotinib in patients with resected Stage IA-IIIA, EGFR-mutated NSCLC who had completed standard adjuvant chemotherapy and/or radiotherapy (Pennell NA, et al. ASCO 2014. Abstract 7514). A total of 100 patients received adjuvant erlotinib for 2 years. At a median follow-up of 3 years, the 2-year mean DFS is 90% and median OS has not been reached. Both of these studies are highly suggestive of a significant DFS benefit of adjuvant erlotinib in patients with resected Stage IA/B-IIIA NSCLC. “Value in practice-changing advances is defined by results that are dramatically better, and we can afford it.” These results suggest that adjuvant erlotinib in this setting falls into this value-added category.