C ompared with other oncogenic drivers, ERBB2 (also known as HER2) tends to have poor prognosis in patients with advanced NSCLC, according to researchers, who noted that the treatment for ERBB2-altered NSCLC has been studied for many years. However, no all-inclusive studies have examined the value of various therapies as first-line treatment.
To fill this knowledge gap, researchers conducted a multicenter retrospective study to evaluate the effectiveness of different treatments. “Through the development of immunotherapy, more and more different combination treatments were [used] in clinical practice, therefore, we conducted a multicenter study to evaluate the efficacy of different treatments,” the study authors wrote. Their findings were published in Lung Cancer.
Most Patients Had Stage IV Diagnosis With Lung Adenocarcinoma
In their investigation, the study team included patients (n=36 with ERBB2 variant; n=29 with ERBB2 amplification) with ERBB2- altered NSCLC who had experienced at least one-line systemic anticancer treatment. They soughtto assess the effectiveness of first-line chemo-therapy alone (chemo), antiERBB2 tyrosine kinase inhibitor (TKI), chemotherapy plus immunotherapy (chemo+ immuno), chemotherapy plus antiangiogenesis therapy (chemo+antiangio) and chemotherapy combined with immunotherapy and antiangiogenesis therapy (chemo+ immuno+antiangio). The clinical outcomes included median progression-free survival (mPFS), disease control rate (DCR), objective response rate (ORR), and 1-year and 3-year survival rates (Table).
The median age of patients enrolled in the study was 59 (range, 36-81); 56.9% were women. Most patients had a diagnosis of stage IV lung cancer (86.2%) and lung adenocarcinoma (93.8%).
To compare counting data, researchers used the chi-squared test or Fisher exact test; the data rank sum test was used to compare measurement data. Survival analysis was generated via the log-rank test and Kaplan Meier method. For HR, 95% confidence interval, and univariate and multivariate analysis, researchers used a Cox proportional hazard regression model. Researchers observed that the mPFS was 5.7 months, overall ORR was 30.8%, and DCR was 69.2% in the cohort. Compared with TKI, chemo+immuno and chemo+antiangio both achieved longer mPFS (7.8 vs 3.6 months; HR, 0.24; 95% CI, 0.09-0.64; P=0.002; 5.9 vs 3.6 months; HR, 0.36; 95% CI, 0.15-0.88; P=0.019; respectively). While no notable difference was found in mPFS between chemo+immuno or chemo+antiangio and chemo (both P>0.05), the mPFS of the first two was longer.
Survival Chances May Increase With First-Line Therapy
For patients with the ERBB2 variant, the mPFS was 5.9 months, and chemo+immuno and chemo+antiangio both achieved longer mPFS than TKI (12.9 vs 2.9 months; HR, 0.15; 95% CI, 0.03-0.68; P=0.005; 7.1 vs 2.9 months, HR, 0.50; 95% CI, 0.29-0.88; P=0.009, respectively). Patients with the ERBB2 variant or amplification showed no statistical significance in PFS (both P>0.05) within the same therapies.
“Our results suggest that compared with ERBB2-target therapy, first-line therapy may increase the chances of survival in patients with ERBB2-altered NSCLC, especially in patients with ERBB2 mutations,” the study authors wrote. However, they added that the effectiveness may not surpass that of chemotherapy. The study team agreed that further studies, especially prospective studies, need to substantiate these ideas in the context of first-line treatment of [patients with] ERBB2-altered NSCLC.
