title: Erlotinib versus pemetrexed for pretreated non-squamous non-small cell lung cancer patients in clinical practice.
abstract: OBJECTIVE
  Erlotinib and chemotherapy have shown similar efficacy for pretreated non-small cell lung cancer (NSCLC) patients, but none of the large studies have selected patients based on histology. We present a retrospective single-center series of advanced non-squamous NSCLC patients treated with erlotinib or pemetrexed as second-line therapy. Our aim was to compare the efficacy and safety data under clinical practice conditions and to identify subgroups of patients who could benefit more from these therapies.
  
  
  METHODS
  A total of 88 patients were included. Squamous histology was our main exclusion criterion. EGFR mutation status was known for 54.5% of the patients; 6 patients treated with erlotinib and 2 with pemetrexed had EGFR-mutated tumors. Smoking history was analyzed as possible predictive factor of efficacy.
  
  
  RESULTS
  No significant differences in progression-free survival (PFS; 3 vs. 2.5 months, p = 0.06) or overall survival (OS; 4.9 vs. 7.4 months, p = 0.733) between the erlotinib and pemetrexed groups were found in the overall population. EGFR wild-type patients had a similar median PFS with erlotinib compared to pemetrexed (2.7 vs. 2.3 months, p = 0.42), with no statistical differences in OS. Statistically significant differences in OS in favor of pemetrexed for current smokers (3 vs. 7.1 months, p = 0.017) were found, while erlotinib achieved significantly better PFS in never-smokers compared to former smokers (3.5 vs. 2.7 months, p = 0.005). Serious adverse events were uncommon but more frequent with pemetrexed, and were mainly related to hematologic toxicity.
  
  
  CONCLUSIONS
  Erlotinib should be considered as another equal option in second-line treatment for EGFR wild-type patients as well as for subpopulations with unknown mutational status. Smoking history could be a useful clinical marker to choose a second-line treatment.
authors: Departments of a Medical Oncology, Hospital Clínico San Carlos, ES–28040 Madrid, Spain. jonzuga@gmail.com
authors: J
authors: J
authors: Zugazagoitia
authors: J
authors: J
authors: Puente
authors: J L
authors: JL
authors: González-Larriba
authors: A
authors: A
authors: Manzano
authors: M
authors: M
authors: Sotelo
authors: S
authors: S
authors: Hernández
authors: J
authors: J
authors: Sanz
authors: P
authors: P
authors: Pérez
authors: E
authors: E
authors: Díaz-Rubio
mesh_terms: D000368:Aged; D000465:Algorithms; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D004252:DNA Mutational Analysis; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000235:genetics; D000069347:Erlotinib Hydrochloride; D005260:Female; D005971:Glutamates / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009154:Mutation; D000068437:Pemetrexed; D016016:Proportional Hazards Models; D011799:Quinazolines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012907:Smoking; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D011799:Quinazolines; D000068437:Pemetrexed; D006147:Guanine; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors