J Cancer 2019; 10(17):4151-4158. doi:10.7150/jca.30507 This issue

Research Paper

Factors associated with improvement in symptoms and quality of life for first-line EGFR-tyrosine kinase inhibitor treatment in patients with EGFR-mutated non-small-cell lung cancer - A multicenter prospective SMILE study

Yu-Feng Wei1,2, Wen-Tsung Huang3, Tu-Chen Liu4, Jiunn-Min Shieh5, Chih-Feng Chian6, Ming-Fang Wu7, Chih-Cheng Chang8,9, Ching-Hsiung Lin10, Jen-Chung Ko11, Chia-Mo Lin12, Te-Chun Hsia13,14✉

1. Division of Chest Department, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
2. Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
3. Division of Hematology-Oncology, Department of Internal Medicine, Chi Mei Medical Center Liouying, Tainan, Taiwan
4. Department of Chest Medicine, Cheng Ching Hospital-Chung Kang Branch, Taichung, Taiwan
5. Department of Internal Medicine, Chi Mei Medical Center - YongKang Branch, Tainan, Taiwan
6. Division of Pulmonary and Critical Care Medicine, Internal Medicine Department, Tri‐Service General Hospital, National Defense Medical Center, Taipei, Taiwan
7. Division of Medical Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, and School of Medicine, Chung Shan Medical University, Taichung, Taiwan
8. Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan
9. Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University.
10. Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
11. Department of Internal Medicine, National Taiwan University Hospital - Hsinchu Branch, Hsinchu, Taiwan
12. Sleep Center, Pulmonary and Critical Care Medicine, Shin Kong Wu Ho‐Su Memorial Hospital, Taipei, Taiwan
13. Department of Respiratory Therapy, China Medical University, Taichung, Taiwan
14. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan

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Citation:
Wei YF, Huang WT, Liu TC, Shieh JM, Chian CF, Wu MF, Chang CC, Lin CH, Ko JC, Lin CM, Hsia TC. Factors associated with improvement in symptoms and quality of life for first-line EGFR-tyrosine kinase inhibitor treatment in patients with EGFR-mutated non-small-cell lung cancer - A multicenter prospective SMILE study. J Cancer 2019; 10(17):4151-4158. doi:10.7150/jca.30507. Available from https://www.jcancer.org/v10p4151.htm

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Abstract

Introduction: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are a standard first-line treatment for advanced EGFR-mutated NSCLC patients. Factors associated with symptoms and quality of life (QOL) improvements have not been investigated.

Methods: We conducted a multicenter, prospective study to evaluate improvements in QOL and symptoms in NSCLC patients treated with first-line EGFR-TKIs. QOL was assessed using the instrument of Functional Assessment of Cancer Therapy-Lung questionnaire (FACT-L) and Treatment Outcome Index (TOI). Assessment of symptoms was evaluated using the Lung cancer subscale (LCS).

Results: Eligible subjects included 280 patients for endpoint analyses. The mean FACT-L score increased by 4.0 ± 15.56 at Week 2 (p<0.001), 5.1 ± 18.48 at Week 4 (p<0.001), and 4.2 ± 20.27 at Week 12 (p=0.001). Similarly, a 2.3 ± 11.65 (p<0.001), 3.2 ± 13.59 (p<0.001), and 2.4 ± 14.34 (p=0.009) increase in mean TOI score were observed at Weeks 2, 4 and 12, respectively. For LCS, it was slightly increased by 1.7 ± 4.61, 2.0 ± 5.50, and 2.0 ± 5.36 at Weeks 2, 4, and 12 (all p<0.001), respectively. Subgroup analyses showed patients who were ex-smokers or with at least 3 metastatic sites were associated with symptoms improvement. Patients who were ex-smokers, with at least 3 metastatic sites, a PS of 1, or treated with gefitinib were associated with QOL improvement.

Conclusions: In EGFR -mutated NSCLC patients who were treated with first-line EGFR-TKIs, these ex-smokers or with 3 or more metastatic sites were associated with improvements in symptoms and QOL.

Keywords: epidermal growth factor receptor tyrosine kinase inhibitor, non-small cell lung cancer, quality of life