title: The EGFR tyrosine kinase inhibitors as second-line therapy for EGFR wild-type non-small-cell lung cancer: a real-world study in People's Republic of China.
abstract: BACKGROUND
  Clinical evidence comparing chemotherapy and tyrosine kinase inhibitors (TKIs) as second-line therapy for epidermal growth factor receptor (EGFR) wild-type non-small-cell lung cancer (NSCLC) are conflicting.
  
  
  METHODS
  We retrospectively reviewed stage IV EGFR wild-type NSCLC patients who relapsed on first-line chemotherapy at the Shanghai Chest Hospital to compare the efficacy of TKIs and chemotherapy as second-line therapy among different clinical subgroups.
  
  
  RESULTS
  The progression-free survival (PFS) and overall survival for patients receiving chemotherapy as second-line therapy for NSCLC were longer than patients who received TKIs. The hazard ratios (HRs) were 0.40 (P<0.001) and 0.50 (P<0.001), respectively. Subgroup analyses showed that second-line TKI therapy resulted in inferior PFS among smokers (HR =0.24,P<0.001), males (HR =0.33,P<0.001), females (HR =0.54,P=0.004), and patients with adenocarcinoma (HR =0.48,P<0.001) and nonadenocarcinoma histology (HR =0.20,P<0.001). Among never-smokers, the PFS in cohorts receiving second-line chemotherapy or TKIs was not significantly different (HR =0.70,P=0.08).
  
  
  CONCLUSIONS
  These results suggest that EGFR TKI therapy was inferior compared to chemotherapy in EGFR wild-type NSCLC patients who relapsed from first-line chemotherapy; however, among never-smokers, these two treatment strategies were comparable.
authors: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors: Jianlin
authors: J
authors: Xu
authors: Department of Pulmonary, Anqing Municipal Hospital, Anhui, People's Republic of China.
authors: Guozheng
authors: G
authors: Ding
authors: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors: Xueyan
authors: X
authors: Zhang
authors: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors: Bo
authors: B
authors: Jin
authors: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors: Yuqing
authors: Y
authors: Lou
authors: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors: Yanwei
authors: Y
authors: Zhang
authors: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors: Huiming
authors: H
authors: Wang
authors: Central laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors: Dan
authors: D
authors: Wu
authors: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
authors: Baohui
authors: B
authors: Han
keywords: NSCLC; TKI; wild-type