Neoadjuvant erlotinib benefits selected epidermal growth factor receptor (EGFR)-mutated patients who undergo complete resection of stage IIIA-N2 stage non-small cell lung cancer (NSCLC). Results of the randomised study comparing erlotinib with gemcitabine plus cisplatin as neoadjuvant treatment, were presented at the ESMO 2018 Congress in Munich.

A total of 386 patients from 17 centres in China were screened in the study and 72 were randomised one to one to therapy and included in the intention-to-treat population. The objective response rate for neoadjuvant erlotinib versus gemcitabine plus cisplatin chemotherapy was 54.1% versus 34.3% with an odds ratio of 2.26. After neoadjuvant therapy, 83.8% of patients in the erlotinib group and 68·6% in the gemcitabine plus cisplatin group underwent surgery.

Median progression-free survival was significantly longer with erlotinib at 21·5 months versus gemcitabine plus cisplatin chemotherapy at 11.9 months with a hazard ratio of 0.42.

Dr Yi-Long Wu, Tenured Professor of Guangdong Lung Cancer Institute, Guangzhou, China, said: “Our results suggest promise for the use of biomarker-guided neoadjuvant EGFR-tyrosine kinase inhibitor (TKI) treatment strategies in stage IIIA-N2 non-small cell lung cancer. This is the first study to demonstrate progression-free survival superiority for erlotinib over gemcitabine plus cisplatin chemotherapy in the neoadjuvant/adjuvant setting of stage IIIA-N2 EGFR mutated NSCLC.”