title: Patient response to use of tyrosine kinase inhibitors in lung cancer: a retrospective audit during funding changes.
abstract: BACKGROUND
  The New Zealand Pharmaceutical Management Agency (PHARMAC) approved funding of erlotinib in October 2010 as second line therapy in all non-squamous non-small cell lung cancer after platinum-based chemotherapy with no requirement for epidermal growth factor (EGFR) mutation testing. Funding widened in August 2012 to include gefitinib as first line treatment for patients with a proven EGFR mutation. Then in January 2014, both tyrosine kinase inhibitors (TKIs) were approved for first line treatment, but only for disease with EGFR mutation.
  
  
  OBJECTIVE
  To report the clinical experience with TKIs in a New Zealand tertiary referral centre over a period of funding change.
  
  
  METHODS
  Retrospective audit of all patients commenced on erlotinib from 1st October 2010 until 1st November 2011, and gefitinib from 1st August 2012 until 31st August 2013. Follow-up was two years for both groups.
  
  
  RESULTS
  Each group had 42 patients. Median Progression Free Survival was 76 days in the erlotinib group and 255 days in the gefitinib group. Twenty-eight percent of erlotinib patients had grade 3 adverse events with one treatment related death; fourteen percent of gefitinib patients had grade 3 adverse events. Dose reduction or treatment breaks were required in 12% in each group.
  
  
  CONCLUSIONS
  Response rate in these audits appear to reflect the change in funding criteria, with improved response rates likely to be associated with more targeted treatment.
authors.affiliation: Advanced Nursing, Cancer and Blood Services, Auckland District Health Board, Auckland.
authors.forename: Anne
authors.initials: A
authors.lastname: Fraser
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D000069347:Erlotinib Hydrochloride / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005380:Financing, Government; D000077156:Gefitinib; D018773:Genes, erbB-1; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D008485:Medical Audit / Q000191:economics; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D011799:Quinazolines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D000077156:Gefitinib