Volume-based growth tumor kinetics as a prognostic biomarker for patients with EGFR mutant lung adenocarcinoma undergoing EGFR tyrosine kinase inhibitor therapy: A case control study

Background: We aim to determine whether volumetric assessment has the potential to serve as a prognostic biomarker, and to assess the relationship between longitudinal tumor data during treatment and prognosis in lung adenocarcinoma patients with sensitizing EGFR mutations treated with EGFR tyrosine kinase inhibitors (TKI). Methods: We retrospectively assessed patients with EGFR-mutant stage IV lung adenocarcinoma who were treated with EGFR TKIs until disease progression. CT studies of 106 patients were quantitatively analyzed in terms of tumor size and volume by comparing baseline and follow-up CT scans obtained at every two treatment cycles. Tumor response was quantified using longitudinal measurements, and tumor growth kinetics was determined. Correlation with early surrogate parameters for tumor response evaluation such as change in size, volume, and response rate was performed. The Cox-proportional hazard model and Log-rank test were used to predict overall survival (OS). Results: Responders based on the percent change in volume after four cycles of TKI therapy had a higher OS than non-responders (P = 0.035). The percent of volume and size changes after four cycles of TKI therapy were significantly correlated with TTP (P < 0.001). Conclusion: Volume measurements and corresponding rates of growth appear to be helpful adjuncts for predicting survival in patients undergoing EGFR-TKI therapy.