title: The impact of rescue or maintenance therapy with EGFR TKIs for Stage IIIb-IV non-squamous non-small-cell lung cancer patients requiring mechanical ventilation.
abstract: BACKGROUND
  The toxicity of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is less than that of cytotoxic agents. The reports of dramatic response and improvement in performance status with the use of EGFR TKIs may influence a physician's decision-making for patients with non-squamous non-small cell lung cancer (NSCLC) and life-threatening respiratory distress. The aim of this study was to evaluate the outcome of rescue or maintenance therapy with EGFR TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation.
  
  
  METHODS
  Eighty-three Asian patients with stage IIIb-IV non-squamous NSCLC and who required mechanical ventilation between June 2005 and January 2010 were evaluated.
  
  
  RESULTS
  Of the 83 patients, 16 (19%) were successfully weaned from the ventilator. The use of EGFR TKI as rescue or maintenance therapy during respiratory failure did not improve the rate of successful weaning (standard care 18% vs. with EGFR TKI, 22%; p = 0.81) in univariate and multivariate analyses.
  
  
  CONCLUSIONS
  Rescue or maintenance therapy with EGFR TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation was not associated with better outcome. An end-of-life discussion should be an important aspect in the care of this group of patients, since only 19% were successfully weaned from mechanical ventilation.
authors: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.
authors: Te-Chun
authors: TC
authors: Hsia
authors: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan.
authors: Chih-Yen
authors: CY
authors: Tu
authors: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan ; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.
authors: Hung-Jen
authors: HJ
authors: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D047428:Protein Kinase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D015300:Ventilator Weaning
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D066246:ErbB Receptors
keywords: EGFR TKI; Respiratory failure; SAPS II score; SOFA score; Stage IIIb-IV non-squamous NSCLC