title: First- or second-line therapy with gefitinib produces equal survival in non-small cell lung cancer.
abstract: BACKGROUND
  Gefitinib is effective in treating patients with non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations. Deletions in exon 19 and L858R in exon 21 are the best-documented EGFR mutations that are associated with effective gefitinib responsiveness.
  
  
  OBJECTIVE
  To clarify the influence of gefitinib timing, we conducted a study to compare the outcomes of different lines of gefitinib treatment in patients with exon 19 deletions or L858R.
  
  
  METHODS
  We surveyed the clinical data and mutational studies of patients with NSCLC with EGFR mutations in the National Taiwan University Hospital (Taipei, Taiwan).
  
  
  RESULTS
  Three hundred and twenty-eight patients, who received gefitinib for stage IIIb or IV NSCLC, were adequately sequenced for EGFR mutations; 192 patients had mutant EGFR, including 77 patients with exon 19 deletions and 75 patients with L858R. The 152 patients with exon 19 deletions or L858R and who were receiving gefitinib were classified into a chemonaive group (91 patients) or a chemotherapy-treated group (61 patients). Chemonaive status before gefitinib and female sex were associated with clinical response to gefitinib (P = 0.006 and 0.053, respectively). Neither overall survival after the start of antitumor therapy nor progression-free survival after gefitinib therapy was significantly different between these two groups (P = 0.207 and 0.804, respectively). Clinical response to gefitinib was the only factor associated with better overall survival (P = 0.001).
  
  
  CONCLUSIONS
  This study suggests that gefitinib is effective in patients with EGFR mutations. The gefitinib response rate in chemonaive patients is higher than in chemotherapy-treated patients; however, there is no difference in overall survival.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 10002, Taiwan.
authors.forename: Jenn-Yu
authors.initials: JY
authors.lastname: Wu
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Yang
authors.forename: Shang-Gin
authors.initials: SG
authors.lastname: Wu
authors.forename: Yueh-Hsia
authors.initials: YH
authors.lastname: Chiu
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Gow
authors.forename: Yeun-Chung
authors.initials: YC
authors.lastname: Chang
authors.forename: Ya-Chieh
authors.initials: YC
authors.lastname: Hsu
authors.forename: Pin-Fei
authors.initials: PF
authors.lastname: Wei
authors.forename: Jin-Yuan
authors.initials: JY
authors.lastname: Shih
authors.forename: Pan-Chyr
authors.initials: PC
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D004273:DNA, Neoplasm / Q000235:genetics*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009154:Mutation; D016133:Polymerase Chain Reaction; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011799:Quinazolines / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology
chemical_list: D004273:DNA, Neoplasm; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D066246:ErbB Receptors; D000077156:Gefitinib