Analysis of the efficiency of integrated chemotherapy in the treatment of patients with non-small cell lung cancer with EGFR L858R mutation in exon 21 using first- and second-generation tyrosine kinase inhibitors

General data. The article presents the results of a comparative analysis of the effectiveness of integrated chemotherapy in targeted anti-EGFR therapy for patients with non-small cell lung cancer (NSCLC) with a mutation in exon 21 of the EGFR gene compared to monotherapy with firstand second-generation tyrosine kinase inhibitors (TKIs).

Material: From 2015 to 2021, the study included 45 patients with metastatic NSCLC with the L858R mutation in exon 21 for the first line of treatment, distributed into an experimental group and a control group of 23 and 22 people, respectively. Patients in the experimental group received therapy with tyrosine kinase inhibitors for the first 2 months, followed by discontinuation of targeted drugs and 3 courses of chemotherapy according to the paclitaxel and carboplatin regimen. Targeted therapy was then resumed until disease progression. Patients in the control group received only monotherapy with first- or second-generation TKIs. The median follow-up was 36 months.

Result. The objective response rate (ORR) was 59.1 % for the experimental group and 27.3 % for the control group, disease stabilization was achieved in 9 (40.9%) patients and 14 (63.6%), respectively. The median progression-free survival (PFS) for the experimental group was 23 months [95% CI: 16–36], for the control group 13 [95% CI: 11–17] (p=0.004). The median overall survival (OS) for the experimental group was statistically higher than in the control group and was 43 [lower limit of 95% CI – 38] months versus 32 [95% CI: 23–44] months (p=0.008).

Conclusion. The results of our study showed that the integration of chemotherapy into targeted treatment of this category of patients may become a new worthy option that allows for a statistically significant increase in both the median PFS and the median OS.

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