title: Sequential treatment of advanced-stage lung adenocarcinoma harboring wild-type EGFR gene: second-line pemetrexed followed by third-line erlotinib versus the reverse sequence.
abstract: BACKGROUND
  Pemetrexed and erlotinib represent novel agents for the treatment of non-small cell lung cancer (NSCLC). The role of sequential treatment in NSCLC has not been elucidated yet. We compared the efficacy of second-line pemetrexed followed by third-line erlotinib (P-E) to treatment with the reverse sequence (E-P).
  
  
  METHODS
  We analyzed data of 57 patients with advanced-stage (IIIB/IV) lung adenocarcinoma harboring wild-type epidermal growth factor receptor (EGFR) gene; 31 patients were treated with P-E and 26 patients with the E-P sequence.
  
  
  RESULTS
  The median progression-free survival (PFS) for patients treated with P-E was 3.6 months vs. 7.8 months for patients treated with E-P (p=0.029). The median overall survival (OS) for patients treated with P-E was 7.9 months vs. 26.3 months for patients treated with E-P (p=0.006).
  
  
  CONCLUSIONS
  The results proved a significant improvement of both PFS and OS for patients treated with the E-P sequence as compared to the P-E sequence.
authors.affiliation: Department of Oncology and Radiotherapy, Medical School and Teaching Hospital in Pilsen, Charles University in Prague, alej Svobody 80, CZ-304 60 Pilsen, Czech Republic. fiala.o@centrum.cz
authors.forename: Ondrej
authors.initials: O
authors.lastname: Fiala
authors.forename: Milos
authors.initials: M
authors.lastname: Pesek
authors.forename: Jindrich
authors.initials: J
authors.lastname: Finek
authors.forename: Lucie
authors.initials: L
authors.lastname: Benesova
authors.forename: Zbynek
authors.initials: Z
authors.lastname: Bortlicek
authors.forename: Marek
authors.initials: M
authors.lastname: Minarik
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; 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* / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed; D011799:Quinazolines / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D005971:Glutamates; D011799:Quinazolines; D000068437:Pemetrexed; D006147:Guanine; D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors
keywords: NSCLC; Pemetrexed; adenocarcinoma; erlotinib; second-line; sequence; third-line