Advanced Lung Cancer Patients’ Use of EGFR Tyrosine Kinase Inhibitors and Overall Survival: Real-World Evidence from Quebec, Canada
, Gino Boily 2,*,†, Jim Boulanger 3, Kossi Thomas Golo 2, Aude-Christine Guédon 2, Camille Lehuédé 2, Ferdaous Roussafi 2, Catherine Truchon 3 and Erin Strumpf 1,†
Round 1
Reviewer 1 Report
In this study, three cohorts (1st-line gefitinib, 1st-line afatinib, and post- 32 EGFR-TKI osimertinib) were created to examine the benefits of three EGFR-TKIs that are publicly funded in Quebec. The authors compared overall survival (OS) among patients receiving these treatments to those in previous experimental and real-world studies. For the gefitinib 1st-line (n=457), the afatinib 1st-line (n=80), and the post-EGFR-TKI osimertinib (n=119) cohorts, they found median OS (in months) of 18.9 (95%CI: 16.3-21.9), 26.6 (95%CI: 13.7-NE) and 19.9 (95%CI: 17.4-NE), respectively. Out of the 20 studies that they reviewed and compared, 17 (85%) had similar OS results. The specific comments are listed below.
Major
1. The authors admitted that they did not verify whether patients had a non-small cell type histology and an activating EGFR mutation. They assumed the patients all had these characteristics because those are the conditions for public coverage for the TKIs (lines 339-342). However, different mutations in the EGFR kinase domain have different susceptibility to the TKI treatments. Not knowing the types of EGFR mutations involved might have affected the analyses of overall survival. Studies done in east Asia might have included various types of EGFR mutations. The authors should look into the literatures reviewed in this study to see if those studies also did not classify mutation types.
2. The labels in the Figs. 3, 4, 5 all have small fonts, even when magnified, that could not be read. These Figs. should be revised with better quality.
Minor
3. “(exons 19 and 21-L858R)” in page 2 (line 62) should be “(exon 19 deletions and exon 21-L858R)”.
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
The study is written well and presented the data in a concise and comprehensive manner. The data is sound and provides similar results as previous relevant literature. Therefore it can be recommended for publication in its present form in Current Oncology.
Author Response
Thank you for your review. We are pleased to know that our manuscript satisfied all reviewing criteria.
