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ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 26-30

comparison of maintenance strategy in EGFR mutation positive and negative locally advanced and metastatic non squamous lung carcinoma.A tertiary center experience


1 Department of Medical Oncology, Indira Gandhi Institute of Medical Sciences, Patna, India
2 Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India

Correspondence Address:
Avinash Pandey
Assistant Professor, Department of Medical Oncology, IGIMS
India
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Source of Support: None, Conflict of Interest: None


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Background and Rationale: Induction platin based doublet is standard of care in locally advanced and metastatic NSCLC. Maintenance pemetrexed and tyrosine kinase inhibitior both have shown to improve outcomes in patients with favourable response to induction therapy. Aim: To evaluate and compare outcomes with maintenance pemetrexed and maintenance TKI in EGFR mutation positive and negative patients. Objectives: To calculate and compare Progression free survival, overall survival and factor affecting outcomes with maintenance pemetrexed and maintenance TKI. Material and Methods: Data of patients with locally advanced and metastatic non squamous NSCLC who received induction pemetrexed platin doublet were retrieved from prospectively maintained lung cancer database registered between June 2011 and March 2014.Patients who received maintenance pemetrexed and maintenance TKI being EGFR mutation negative and positive respectively were chosen for final analysis. Kaplan Meir survival analysis was used for Progression free survival and overall survival. Log rank test was used to evaluate and compare factors affecting outcome. Result: Median follow up is 16 months. Out of 268 patients who had favourable response to induction pemetrexed platin doublet, EGFR mutation result was available in 238 (89%) patients. Patients who were EGFRF mutation negative and received maintenance pemetrexed were 138, while those with EGFR mutation positive and received maintenance TKI were 80.Median PFS with maintenance TKI in EGFR mutation positive patients was significantly better than that of maintenance pemetrexed in EGFR mutation negative (11 months versus 8 months; p=0.01), while the overall survival was 19 months and 20 months respectively. Older age, females, non smoker, no baseline effusion and partial response to induction did better with maintenance TKI. Conclusion: Maintenance TKI in EGFR mutation positive non squamous NSCLC delays disease progression more than maintenance pemetrexed in EGFR mutation negative NSCLC. Both option fare favourably to improve outcomes after response to induction therapy.


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