Is the importance of achieving stable disease different between epidermal growth factor receptor tyrosine kinase inhibitors and cytotoxic agents in the second-line setting for advanced non-small cell lung cancer?
BACKGROUND
It is controversial whether achieving stable disease leads to a survival benefit and whether the importance of achieving stable disease differs between cytotoxic agents and molecular targeted agents. To examine these questions, the authors retrospectively reviewed phase II and III studies in the second-line setting for advanced non-small cell lung cancer using epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and cytotoxic agents separately.


METHODS
The authors chose 45 trials for the chemotherapy group and nine for the EGFR TKI group by searching the PubMed database. All nine trials in the EGFR TKI group concern gefitinib and erlotinib.


RESULTS
The median survival time increased 0.0375 month with each 1% increase in stable disease rate (p = 0.039), and each 1% increase in response rate resulted in 0.0744 (p < 0.001) month of median survival time in the analysis combined with both cytotoxic agents and EGFR TKIs. Main and interaction terms for EGFR TKI treatment were not statistically significant. With respect to time to progression, only response rate showed a statistically significant relationship with survival.


CONCLUSIONS
To obtain response seems to be more important than to achieve stable disease for both cytotoxic agents and EGFR TKIs, although achieving stable disease is still valuable. The relationship between survival and response or stable disease appears similar for cytotoxic agents and EGFR TKIs.
Kurata
Takayasu
T
Department of Medical Oncology, Kinki University School of Medicine, Osaka, Japan. kurata@hp.pref.hyogo.jp
Matsuo
Keitaro
K
Takada
Minoru
M
Kawahara
Masaaki
M
Tsuji
Masahiro
M
Matsubara
Yuka
Y
Otani
Nagahiro
N
Matsuyama
Shigeki
S
Muraishi
Kenya
K
Fujita
Tetsuya
T
Ishikawa
Masato
M
Koyano
Keita
K
Okamoto
Isamu
I
Satoh
Taroh
T
Tamura
Kenji
K
Nakagawa
Kazuhiko
K
Fukuoka
Masahiro
M
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate
D000970:Antineoplastic Agents; D066246:ErbB Receptors