The Impact of Baseline Vitamin D Level in Patients Receiving Gefitinib-Directed Therapy for EGFR-Mutant Non-Small-Cell Lung Cancer

Vanita Noronha; Manali Kolkur; R ArunKumar; Supriya Adak; Vijay Patil; Nandini Menon; Minit Shah; Kumar Prabhash

doi:10.1177/11795549241254460

The Impact of Baseline Vitamin D Level in Patients Receiving Gefitinib-Directed Therapy for EGFR-Mutant Non-Small-Cell Lung Cancer

Clin Med Insights Oncol. 2024 May 31:18:11795549241254460. doi: 10.1177/11795549241254460. eCollection 2024.

Authors

Vanita Noronha^{1

2}, Manali Kolkur^{1

2}, R ArunKumar^{1

2}, Supriya Adak^{1

2}, Vijay Patil³, Nandini Menon^{1

2}, Minit Shah^{1

2}, Kumar Prabhash^{1

2}

Affiliations

¹ Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India.
² Homi Bhabha National Institute (HBNI), Mumbai, India.
³ P. D. Hinduja Hospital & Medical Research Centre, Mahim, India.

Abstract

Background: There is contradicting evidence on vitamin D levels and cancer mortality rates. In this study, we aimed to evaluate the impact of baseline vitamin D level on the outcome in patients with estimated glomerular filtration rate (EGFR)-mutant advanced non-small-cell lung cancer (NSCLC) who received either gefitinib or gefitinib with chemotherapy (pemetrexed and carboplatin) as first-line therapy in a prospective randomized study.

Methods: This was a post hoc analysis of a phase III randomized trial comparing gefitinib with gefitinib with carboplatin and pemetrexed in patients with advanced NSCLC with activating EGFR mutations in the first-line setting. As a part of regular practice, baseline vitamin D levels were measured using circulating 25(OH) levels in blood. We included 334 patients who had baseline vitamin D levels in the study and evaluated the effect of the vitamin D level on oncologic outcomes.

Results: There were 136 (40.7%) patients with a sufficient (>20 ng/mL) baseline vitamin D level, and 198 (59.3%) patients who were deficient in vitamin D (<20 ng/mL). The median progression-free survival (PFS) in patients with normal vitamin D levels was 17 months, whereas that in patients with deficient vitamin D levels was 15 months, with a hazard ratio of 1.45 (95% confidence interval [CI] = 1.03-2.06). The median overall survival (OS) in patients with normal vitamin D levels was 28.6 months, whereas that in patients with deficient vitamin D levels was 28.5 months, with a hazard ratio of 1.17 (95% CI = 0.81-1.68). On multivariate analysis, only 2 factors impacted the PFS, the baseline vitamin D level, and the treatment regimen; other factors like age, sex, disease stage, and performance status did not.

Conclusions: Baseline vitamin D levels have a significant impact on PFS, whereas OS is not affected by the baseline vitamin D levels on patients receiving targeted therapy for EGFR-mutant lung cancer.

Trial registration: The trial was prospectively registered with the Clinical Trial Registry of India, registration number CTRI/2016/08/007149. The date of the registration was 5 August 2016.

Keywords: EGFR; Vitamin D; chemotherapy; gefitinib; non–small-cell lung cancer.