title: Epidermal Growth Factor Receptor (EGFR)-Tyrosine Kinase Inhibitor Treatment and Salvage Chemotherapy in EGFR-Mutated Elderly Pulmonary Adenocarcinoma Patients.
abstract: BACKGROUND
  Lung cancer is frequently a disease of elderly patients. However, these patients are often treated less actively owing to a higher comorbidity rate and poor performance status. The efficacy of different treatments in elderly patients with epidermal growth factor receptor (EGFR)-mutated lung cancer is still unknown.
  
  
  METHODS
  We retrospectively reviewed the records of our pulmonary adenocarcinoma patients treated between 2010 and 2013. Data on patient age, type of tumor EGFR mutation, response to first-line EGFR-tyrosine kinase inhibitor (TKI) treatment, type of salvage chemotherapy, and efficacy of EGFR-TKI and salvage chemotherapy were collected.
  
  
  RESULTS
  In all, 473 of 1,230 stage IV adenocarcinoma patients had an EGFR mutation, and 330 of them received first-line TKI treatment. Of the 330 patients, 160 were ≥70 years old (elderly group) and 170 were <70 years old (younger group). The response rate and progression-free survival (PFS) with first-line TKI treatment were not significantly different. The elderly group had shorter median survival. A total of 107 patients received salvage chemotherapy after first-line EGFR-TKI treatment: 45 in the elderly group and 62 in the younger group. Their response rate and PFS were not significantly different; however, the younger group had longer median survival. Additional subgroup analysis showed that younger patients who received platinum-based chemotherapy or combination chemotherapy had better median survival than did the elderly patients. The PFS was longer among younger patients receiving a platinum-based regimen than that among the elderly patients.
  
  
  CONCLUSIONS
  Elderly patients with disease progression after first-line EGFR-TKI treatment can receive chemotherapy and have a response rate similar to that of younger patients.
  
  
  CONCLUSIONS
  The aim of the present study was to investigate the efficacy of first-line epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatment in elderly patients and the outcomes of subsequent salvage chemotherapy after disease progression. The most important finding was that elderly patients with disease progression after first-line EGFR-TKI treatment can receive salvage chemotherapy and have a response rate similar to that of younger patients who received salvage chemotherapy.
authors.affiliation: Department of Chest Medicine and Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Taipei Hospital, Ministry of Health and Welfare, Taiwan, Republic of China; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Yen-Han
authors.initials: YH
authors.lastname: Tseng
authors.affiliation: Department of Chest Medicine and Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Taipei Hospital, Ministry of Health and Welfare, Taiwan, Republic of China; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Yen-Chiang
authors.initials: YC
authors.lastname: Tseng
authors.affiliation: Department of Chest Medicine and Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Taipei Hospital, Ministry of Health and Welfare, Taiwan, Republic of China; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Yi-Hsuan
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Department of Chest Medicine and Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Taipei Hospital, Ministry of Health and Welfare, Taiwan, Republic of China; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Chest Medicine and Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Taipei Hospital, Ministry of Health and Welfare, Taiwan, Republic of China; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Reury-Perng
authors.initials: RP
authors.lastname: Perng
authors.affiliation: Department of Chest Medicine and Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Taipei Hospital, Ministry of Health and Welfare, Taiwan, Republic of China; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Whang-Peng
authors.affiliation: Department of Chest Medicine and Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Taipei Hospital, Ministry of Health and Welfare, Taiwan, Republic of China; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan, Republic of China ymchen@vghtpe.gov.tw.
authors.forename: Yuh-Min
authors.initials: YM
authors.lastname: Chen
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D066246:ErbB Receptors / Q000037:antagonists & inhibitors / Q000235:genetics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality / Q000473:pathology; D008297:Male; D009154:Mutation; D000068437:Pemetrexed / Q000008:administration & dosage; D010984:Platinum / Q000494:pharmacology; D047428:Protein Kinase Inhibitors / Q000737:chemistry / Q000627:therapeutic use*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors; D000068437:Pemetrexed; D000068258:Bevacizumab; D010984:Platinum; D016190:Carboplatin; C512478:EGFR protein, human; D066246:ErbB Receptors; D002945:Cisplatin
keywords: Adenocarcinoma; Elderly; Epidermal growth factor receptor; Tyrosine kinase inhibitors