Sequential Administration of EGFR-TKI and Pemetrexed Achieved a Long Duration of Response in Advanced NSCLC Patients with EGFR-mutant Tumours

Document Type : Research Articles


Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.


Objectives: The optimal combination of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors
(TKIs) and chemotherapy has helped to improve therapeutic effects in non-small-cell lung cancer (NSCLC). This study
aimed to explore the progression free survival (PFS) of patients after sequential administration of TKI and pemetrexed
chemotherapy. Methods: This study retrospectively screened treatment-naive advanced NSCLC patients harbouring
EGFR mutations who were prescribed a TKI and salvaged with pemetrexed chemotherapy or vice versa. The total,
initial and salvage PFS were collected. Results: The total PFS including both the initial and salvage PFS was 18.0 mon
(95% CI: 14.1–21.9 mon), which was not influenced by the sequence of administration (TKI first: 18.0 mon, 95% CI:
15.8–20.2 mon, pemetrexed first: 16.1 mon, 95% CI: 9.1–23.1 mon, HR 0.92, P=0.748). A longer PFS was achieved
for TKI over chemotherapy in both the initial (10.6 and 5.9 mon, HR 2.62, P=0.001) and salvage therapy (12.0 and 6.0
mon, HR 1.29, P=0.001). TKI remained effective either before (10.6 mon) or after (12.0 mon) chemotherapy (HR 0.96,
P=0.853). The same trend was observed for chemotherapy (5.9 and 6.0 mon for initial and salvage therapy, respectively,
HR 0.82, P=0.417). Conclusions: The sequential administration of TKI and pemetrexed chemotherapy achieved a long
PFS and was a suitable treatment for advanced NSCLC.


Main Subjects