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Icotinib plus radiotherapy ups survival in elderly with esophageal cancer

JAMA Network Open
Reuters Health - 15/10/2020 - Icotinib with concurrent radiotherapy (RT) boosts survival and may have other benefits compared to RT alone in elderly patients with unresectable esophageal squamous cell carcinoma, according to Chinese researchers.

Dr. Shixiu Wu told Reuters Health by email, "I think our trial is the first involving the combination of targeted therapy and RT in old people with esophageal cancer and we demonstrated that it improved the overall survival with less toxicity."

In a paper in JAMA Network Open, Dr. Wu of the Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, and colleagues say their essential hypothesis was that the combination "would promote local and regional effects as well as diminish distant metastases."

They note that in preclinical studies, the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor icotinib has markedly inhibited proliferation of human epidermoid squamous carcinoma cell lines with a high level of EGFR.

To investigate further, the researchers conducted a multicenter, open-label trial involving 127 patients aged 70 or older with advanced unresectable esophageal squamous cell carcinoma, all of whom were prescribed RT at 60 Gy in 30 fractions. Participants were randomly assigned to receive or not receive icotinib, 125 mg t.i.d.

After a median follow-up of 42.8 months, the overall response rate was 84.4% in the intervention group and 60.3% in the control group. The median overall survival (OS) was 24.0 months with RT plus icotinib and 16.3 months with RT alone.

No between-group differences were seen in grade 3 or 4 adverse events and toxic effects were well controlled with appropriate dose reductions and supportive care.

In the RT plus icotinib group, median overall survival was not reached among patients with EGFR overexpression; it was 16.3 months in those with low EGFR expression.

Thus, concluded Dr. Wu, patients with higher EGFR expression benefit from the addition of icotinib, "which suggests precise targeting of EGFR-driven esophageal squamous cell carcinoma should remain an important therapeutic aim despite the recent focus on immune checkpoint inhibitors application in esophageal cancer. That may extend to other types of cancer."

By David Douglas

SOURCE: https://bit.ly/3lELPyy JAMA Network Open, online October 7, 2020.

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