RETROSPECTIVE PRACTICE REVIEW OF METASTATIC NON-SMALL CELL LUNG CANCER TREATMENT WITH SECOND-LINE ERLOTINIB

[摘要] BACKGROUND: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and chemotherapy have both demonstrated efficacy in recurrent metastatic non-small cell lung cancer (NSCLC) following failure of first-line platinum-based chemotherapy. Although the three available therapeutic agents – docetaxel, erlotinib and pemetrexed – have significantly changed the treatment landscape for recurrent NSCLC, the optimal selection of second- and third-line therapy has not been established. This practice review examines the outcomes of using second-line erlotinib followed by third-line chemotherapy in the treatment of recurrent metastatic NSCLC in clinical practice. METHODS: A retrospective review of NSCLC patient charts was conducted at three Canadian institutions. Patients with recurrent NSCLC who had received second-line erlotinib therapy followed by third-line chemotherapy were selected by census. Key outcomes assessed through the chart review included time to progression (TTP), response and changes in performance status (PS). Outcomes were also examined for specific patient subgroups.RESULTS: Thirty-five patients were identified retrospectively for this practice review. First-line platinum-doublet therapy demonstrated a mean TTP of 6.6 months and a 46% overall response rate (15 partial responses and one complete response). Second-line treatment with erlotinib produced the highest mean TTP of all lines of therapy (9.2 months) and an overall response rate of 40% (all partial responses). In the third-line setting, where the majority of patients received docetaxel, the mean TTP was 4.3 months and the overall response rate was 18% (all partial responses). Subgroup analysis showed all patient subgroups demonstrated benefit from second-line erlotinib treatment with improved benefit in patients who developed rash, female patients, never smokers, Asians, patients with positive EGFR status, and patients with adenocarcinoma histology.CONCLUSION: For patients with advanced NSCLC who progressed following first-line platinum-based chemotherapy, the data demonstrated that second-line EGFR-TKI treatment was efficacious and well-tolerated, and did not appear to diminish the benefit of third-line chemotherapy.

[学科分类] 肿瘤学