title: Trajectory of chemotherapy for patients with EGFR wild-type advanced pulmonary adenocarcinoma: a single-institution retrospective study.
abstract: BACKGROUND
  Pulmonary adenocarcinoma, recently benefited by new cytotoxic and molecularly targeted drugs, has been classified by driver mutations, such asEGFRmutations. The aim of this study was to research the proportions of patients treated with first- to third-line chemotherapy and to find influential factors for the introduction of chemotherapy and survival benefit from chemotherapy.
  
  
  METHODS
  Data were collected retrospectively on patients who met the following criteria: adenocarcinoma, diagnosed between June 2007 and March 2015 at our hospital, stage IIIB or IV, andEGFRwild type. A nonchemotherapy group of patients who did not receive chemotherapy was compared with a chemotherapy group of patients who received it. The patients who had received first- to third-line chemotherapy between June 2007 and November 2015 at our hospital were also analyzed.
  
  
  RESULTS
  During the study period, 46 patients did not receive chemotherapy, while 148, 89, and 48 received first-, second- and third-line chemotherapy, respectively. As predictive factors for unlikely chemotherapy, multivariate logistic analysis detected Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, hemoglobin <13.2 g/dL, creatinine clearance (Ccr) <50.4 mL/min, and CRP ≥0.53 mg/dL. As factors predicting shorter survival after chemotherapy, multivariate Cox proportional-hazard analyses detected age ≥75 years, ECOG PS ≥2, lower lymphocyte counts, and higher CRP for the first line; female, higher neutrophil counts, lower lymphocyte counts, reduced Ccr, hyponatremia, and shorter interval between first- and second-line chemotherapy for the second line; and age ≥75 years, body mass index <18.5 kg/m2, higher neutrophil counts, lower lymphocyte counts, hyponatremia, higher lactate dehydrogenase, and higher CRP for the third line.
  
  
  CONCLUSIONS
  Approximately 76% of patients were treated with first-line chemotherapy. Of those patients, 61% and 34% proceeded to second- and third-line chemotherapy, respectively. For patients with poor PS, anemia, reduced Ccr, and higher CRP, it is difficult to introduce chemotherapy.
authors.affiliation: Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Minami
authors.affiliation: Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ogata
authors.affiliation: Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan.
authors.forename: Shouichi
authors.initials: S
authors.lastname: Ihara
authors.affiliation: Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Komuta
keywords: EGFR wild type; adenocarcinoma; first-line chemotherapy; non-small-cell lung cancer; second-line chemotherapy; third-line chemotherapy