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DOI: 10.1055/s-0045-1808002
Impact of gefitinib combined with chemotherapy in lung cancer patients with classic EGFR mutations: a real-world study at Barretos Cancer Hospital
Authors
Background: Non-small cell lung cancer (NSCLC) is a major public health issue. At Barretos Cancer Hospital, 540 new cases are reported annually, with 70% presenting as metastatic disease. Approximately 15% of lung adenocarcinomas harbor classic EGFR mutations, making them responsive to tyrosine kinase inhibitors (TKIs) such as gefitinib. However, resistance to first-generation TKIs often develops after 10 to 14 months of treatment. Combining chemotherapy with targeted therapy may provide a synergistic effect, potentially extending the benefits of EGFR-TKI therapy.
Aim: To evaluate the impact of combining platinum-based chemotherapy with gefitinib in a real-world setting, specifically within the SUS (Sistema Único de Saúde), and to explore the intensification of treatment strategies.
Methods: This retrospective study reviewed 70 patients with advanced lung adenocarcinoma and classic EGFR mutations who received gefitinib combined with chemotherapy (pemetrexed and carboplatin) every three weeks for four cycles, followed by gefitinib with pemetrexed maintenance every three weeks as first-line palliative treatment from January 2020 to January 2024. Treatment continued until disease progression, unacceptable side effects, or loss to follow-up. Primary outcomes, including Overall Response Rate (ORR) and Progression-Free Survival (PFS), were analyzed using SPSS software.
Results: The majority of patients were female, non-smokers, and from the southeastern region of Brazil. The ORR was 77%, with 17.9% achieving a complete response. The median PFS was 24 months. Central nervous system progression was the most common site of relapse. 16.9% of patients continued with gefitinib and chemotherapy until further progression or development of resistance mechanisms to first-generation TKIs. The median overall survival (OS) was not reached, but 54.3% of patients were alive at the final analysis. The safety profile of the combination was consistent with known profiles of the individual agents. Among those who experienced toxicities, 16 patients discontinued chemotherapy and continued with gefitinib alone.
Conclusion: This study suggests that combining gefitinib with chemotherapy offers significant clinical benefits and could be a viable treatment option within the SUS framework, especially where other treatments are limited.
Corresponding author: Isabela Fernandes Rivelli Cardoso (e-mail: isabela_rivelli@hotmail.com).
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
06 May 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
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Isabela Fernandes Rivelli Cardoso, Gabriela Panini Batagelo, Rodrigo de Oliveira Cavagna, Josiane Mourão Dias, Amelia Gontijo Velozo de Melo, Carlos Eduardo Baston Silva, Gustavo Dix Junqueira Pinto, Augusto Perazzolo Antoniazzi, Leticia Ferro Leal, Flavio Augusto Ferreira da Silva. Impact of gefitinib combined with chemotherapy in lung cancer patients with classic EGFR mutations: a real-world study at Barretos Cancer Hospital. Brazilian Journal of Oncology 2025; 21.
DOI: 10.1055/s-0045-1808002