Erlotinib as salvage treatment after failure to first-line gefitinib in non-small cell lung cancer.
OBJECTIVE
Chemotherapy is the mainstay treatment for advanced non-small cell lung cancer (NSCLC). Gefitinib, an epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), has been recently shown to be effective as a first-line treatment in Asian patients with advanced NSCLC, especially for those with favourable clinical features such as female, non-smoker and adenocarcinoma. However, resistance to gefitinib ensues invariably and there is little evidence as for the effectiveness of subsequent salvage treatment. The purpose of this study is to evaluate the efficacy of erlotinib, another EGFR-TKI, after failed first-line use of gefitinib.


METHODS
Retrospective review of NSCLC patients with favourable clinical features who received gefitinib as first-line treatment and subsequent salvage treatment with erlotinib.


RESULTS
A total of 21 patients with NSCLC were included in the study. Among them, 18 (85.7%) patients had disease control with gefitinib and 12 (57.1%) patients with salvage erlotinib. There was an association between the disease control with gefitinib and erlotinib (p = 0.031). The disease control rate of erlotinib was independent of the chemotherapy use between the two EGFR-TKIs.


CONCLUSIONS
For NSCLC patients with favourable clinical features, erlotinib was effective in those who had prior disease control with first-line gefitinib.
Wong
Matthew K
MK
Division of Respiratory Medicine, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Lo
Alvis I
AI
Lam
Bing
B
Lam
W K
WK
Ip
Mary S
MS
Ho
James C
JC
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D000069347:Erlotinib Hydrochloride; D005260:Female; D000077156:Gefitinib; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use*; D016879:Salvage Therapy / Q000379:methods*; D017211:Treatment Failure
D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D000077156:Gefitinib
Clin Cancer Res. 2006 Oct 1;12(19):5764-9
17020982
Jpn J Clin Oncol. 2006 Aug;36(8):523-6
16803841
N Engl J Med. 2002 Jan 10;346(2):92-8
11784875
J Clin Oncol. 2005 Oct 20;23(30):7738-40
16234533
J Thorac Oncol. 2007 Aug;2(8):758-61
17762344
Clin Cancer Res. 2007 Jun 15;13(12):3731-7
17575239
Lancet. 2005 Oct 29-Nov 4;366(9496):1527-37
16257339
J Thorac Oncol. 2008 Apr;3(4):400-4
18379359
CA Cancer J Clin. 2006 Mar-Apr;56(2):106-30
16514137
J Clin Oncol. 2007 Jun 20;25(18):2528-33
17577030
PLoS Med. 2005 Mar;2(3):e73
15737014
Lung Cancer. 2009 Aug;65(2):204-7
19110337
Clin Cancer Res. 2008 Nov 1;14(21):7060-7
18981003
Clin Oncol (R Coll Radiol). 2006 Oct;18(8):637-9
17051957
BMC Cancer. 2007 Mar 20;7:51
17374153
JAMA. 2003 Oct 22;290(16):2149-58
14570950
J Clin Oncol. 2005 Apr 10;23(11):2445-59
15753456
J Clin Oncol. 2003 Jun 15;21(12):2237-46
12748244
Ann Oncol. 2008 Dec;19(12):2039-42
18644828
PLoS Med. 2005 Jan;2(1):e17
15696205
J Clin Oncol. 2006 Jan 1;24(1):64-9
16382114
Nat Rev Cancer. 2007 Mar;7(3):169-81
17318210
Lung Cancer. 2007 Dec;58(3):414-7
17618013
Clin Cancer Res. 2005 Apr 15;11(8):3032-7
15837758
N Engl J Med. 2005 Feb 24;352(8):786-92
15728811
J Natl Cancer Inst. 2000 Feb 2;92(3):205-16
10655437
Lung Cancer. 2005 Dec;50(3):417-8
16129510
J Thorac Oncol. 2008 Aug;3(8):912-4
18670311
J Clin Oncol. 2006 Aug 20;24(24):3831-7
16921034
BMJ. 1995 Oct 7;311(7010):899-909
7580546