Advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations represents a subset of patients who may benefit from targeted therapies in addition to standard chemotherapy. This study evaluates the efficacy and safety of combining pemetrexed and carboplatin with erlotinib in EGFR-mutated NSCLC compared to chemotherapy alone.

Methods. A retrospective analysis was conducted on 45 patients with stage IIIB/IV EGFR-mutated NSCLC treated at the Republican Scientific-Practical Medical Center of Oncology and Radiology, Tashkent City Branch, from January 2021 to December 2023. Patients were divided into two groups: Group 1 (n=22) received pemetrexed (500 mg/m²) plus carboplatin (AUC 5) every 21 days for up to 6 cycles; Group 2 (n=23) received the same chemotherapy regimen plus erlotinib (150 mg daily) as maintenance therapy. Primary endpoints were progression-free survival (PFS) and overall response rate (ORR). Secondary endpoints included overall survival (OS) and adverse events.

Results. The median PFS was 8.2 months (95% CI: 6.5–10.1) in Group 1 versus 14.7 months (95% CI: 12.3–17.2) in Group 2 (HR 0.48, 95% CI: 0.26–0.89; p=0.018). ORR was 27.3% in Group 1 and 56.5% in Group 2 (p=0.032). Median OS was 18.4 months in Group 1 and 26.1 months in Group 2 (HR 0.55, 95% CI: 0.29–1.04; p=0.065). Grade 3/4 adverse events were comparable, with neutropenia more frequent in Group 1 (18.2% vs. 8.7%) and rash in Group 2 (13.0% vs. 4.5%).

Conclusions. Addition of erlotinib to pemetrexed-carboplatin significantly improves PFS and ORR in EGFR-mutated advanced NSCLC, with a trend toward better OS. This regimen appears safe and warrants further prospective validation in larger cohorts.

Non-small cell lung cancer, EGFR mutation, Pemetrexed

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