Comparison of concurrent chemoradiation with daily gefitinib versus daily erlotinib in locally advanced oropharyngeal cancers

Background: Concurrent chemoradiation had been the standard of care for locally advanced oropharyngeal cancers. The addition of newer targeted therapies such as cetuximab has resulted in improved locoregional control rates along with tolerable toxicities. The aim of this study was to evaluate the response with addition of newer generation of systemic targeted agents (gefitinib and erlotinib) in combination with chemoradiotherapy for locally advanced oropharyngeal cancer. Materials and Methods: A total of fifty patients of locally advanced carcinoma oropharynx were randomized by odd–even technique to two arms. Arm A (24 patients) received radiotherapy along with concurrent weekly carboplatin 150 mg and daily gefitinib 250 mg, whereas Arm B (25 patients) received erlotinib 150 mg daily along with same chemoradiation regimen as in arm A. Results: The mean age group in the gefitinib and erlotinib groups was 56.9 and 55.1 years. The most common subsite was base of tongue followed by tonsil. The complete response rate was nearly the same in both the arms at the end of treatment. At the end of 1 and 2 years, the disease-free survival (DFS) was more in the gefitinib group as compared to erlotinib group (41.6% vs. 29.1%) and (33.3% vs. 25%), respectively. Conclusion: There was no significant improvement in DFS and OS with the administration of tyrosine kinase inhibitor (TKI) along with concurrent chemoradiotherapy. This might be attributed to the fact that longer duration of TKI was not administered, variable bioavailability of TKIs, and other immune-dependent mechanism when compared to cetuximab and other monoclonal antibodies.