title: Sequential treatment of icotinib after first-line pemetrexed in advanced lung adenocarcinoma with unknown EGFR gene status.
abstract: BACKGROUND
  In non-small cell lung cancer (NSCLC), the well-developed epidermal growth factor receptor (EGFR) is an important therapeutic target. EGFR activating gene mutations have been proved strongly predictive of response to EGFR-tyrosine kinase inhibitors (TKI) in NSCLC. However, both in daily clinical practice and clinical trials, patients with unknown EGFR gene status (UN-EGFR-GS) are very common. In this study, we assessed efficacy and tolerability of sequential treatment of first-line pemetrexed followed by icotinib in Chinese advanced lung adenocarcinoma with UN-EGFR-GS.
  
  
  METHODS
  We analyzed 38 patients with advanced lung adenocarcinoma with UN-EGFR-GS treated with first-line pemetrexed-based chemotherapy followed by icotinib as maintenance or second-line therapy.
  
  
  RESULTS
  The response rates to pemetrexed and icotinib were 21.1% and 42.1%, respectively. The median overall survival was 27.0 months (95% CI, 19.7-34.2 months). The 12-month overall survival probability was 68.4%. The most common toxicities observed in icotinib phase were rashes, diarrheas, and elevated aminotransferase. Subgroup analysis indicated that the overall survival is correlated with response to icotinib.
  
  
  CONCLUSIONS
  The sequence of first-line pemetrexed-based chemotherapy followed by icotinib treatment is a promising option for advanced lung adenocarcinoma with UN-EGFR-GS in China.
authors.affiliation: 1 Department of Medical Oncology, 2 Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China.
authors.forename: Yulong
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: 1 Department of Medical Oncology, 2 Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China.
authors.forename: Weijia
authors.initials: W
authors.lastname: Fang
authors.affiliation: 1 Department of Medical Oncology, 2 Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Deng
authors.affiliation: 1 Department of Medical Oncology, 2 Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Zhao
authors.affiliation: 1 Department of Medical Oncology, 2 Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China.
authors.forename: Nong
authors.initials: N
authors.lastname: Xu
authors.affiliation: 1 Department of Medical Oncology, 2 Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China.
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhou
keywords: Non-small cell lung cancer (NSCLC); chemotherapy; epidermal growth factor receptor (EGFR); tyrosine kinase inhibitor (TKI)
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