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Retrospective practice review of treatment of metastatic non-small-cell lung cancer with second-line erlotinib.

Melosky B, Agulnik J, Assi H - Curr Oncol (2008)

Bottom Line: Although the 3 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.In the third-line setting, in which most patients received docetaxel, the mean ttp was 4.3 months and the overall response rate was 18% (all being partial responses).Subgroup analysis showed that all patient subgroups demonstrated benefit from second-line erlotinib treatment; improved benefit was observed in patients who developed rash, in female patients, in never smokers, in Asian patients, in patients with positive EGFR status, and in patients with adenocarcinoma histology.

View Article: PubMed Central - PubMed

Affiliation: BC Cancer Agency, Vancouver, BC. BMelosky@bccancer.bc.ca

ABSTRACT

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 3 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 in clinical practice of using second-line erlotinib followed by third-line chemotherapy in the treatment of recurrent metastatic NSCLC.

Methods: We conducted a retrospective review of nsclc patient charts at three Canadian institutions. Patients with recurrent nsclc who had received second-line erlotinib therapy followed by third-line chemotherapy were selected by census. A chart review assessed key outcomes that included time to progression (TTP), response, and change in performance status. Outcomes for specific patient subgroups were also examined.

Results: We identified 35 patients for this retrospective 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 1 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 being partial responses). In the third-line setting, in which most patients received docetaxel, the mean ttp was 4.3 months and the overall response rate was 18% (all being partial responses). Subgroup analysis showed that all patient subgroups demonstrated benefit from second-line erlotinib treatment; improved benefit was observed in patients who developed rash, in female patients, in never smokers, in Asian patients, in patients with positive EGFR status, and in patients with adenocarcinoma histology.

Conclusions: For patients with advanced nsclc who progressed following first-line platinum-based chemotherapy, the data demonstrate that second-line EGFR-TKI treatment is efficacious and well-tolerated and that it does not appear to diminish the benefit of third-line chemotherapy.

No MeSH data available.


Related in: MedlinePlus

Median second-line time to progression by patient subgroup. Adeno = adenocarcinoma; egfr = epidermal growth factor receptor; pos = positive mutational status; neg = negative mutational status.
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f2-co15-6-279: Median second-line time to progression by patient subgroup. Adeno = adenocarcinoma; egfr = epidermal growth factor receptor; pos = positive mutational status; neg = negative mutational status.

Mentions: Further analyses of this study population demonstrated that female sex and Asian race also conferred improvements in ttp with second-line erlotinib therapy as compared with male sex and non-Asian race respectively. However, it should be noted that the current/ever smoker, male, and non-Asian subgroups also did better in this review than in previous reports. Our findings align with analyses from controlled trials, such as the br.21 trial, demonstrating that all patient subgroups benefit from erlotinib treatment, and that patients with certain defined clinical characteristics may do better than the average seen for all second-line agents 8. We also calculated and compared TTP for EGFR-positive and EGFR-negative patients; however, mutational status was unknown for 77% of the study population. Table VI summarizes ttp with second-line erlotinib therapy in populations of interest. Figure 2 compares median second-line ttp values for the populations of interest mentioned here.


Retrospective practice review of treatment of metastatic non-small-cell lung cancer with second-line erlotinib.

Melosky B, Agulnik J, Assi H - Curr Oncol (2008)

Median second-line time to progression by patient subgroup. Adeno = adenocarcinoma; egfr = epidermal growth factor receptor; pos = positive mutational status; neg = negative mutational status.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2601023&req=5

f2-co15-6-279: Median second-line time to progression by patient subgroup. Adeno = adenocarcinoma; egfr = epidermal growth factor receptor; pos = positive mutational status; neg = negative mutational status.
Mentions: Further analyses of this study population demonstrated that female sex and Asian race also conferred improvements in ttp with second-line erlotinib therapy as compared with male sex and non-Asian race respectively. However, it should be noted that the current/ever smoker, male, and non-Asian subgroups also did better in this review than in previous reports. Our findings align with analyses from controlled trials, such as the br.21 trial, demonstrating that all patient subgroups benefit from erlotinib treatment, and that patients with certain defined clinical characteristics may do better than the average seen for all second-line agents 8. We also calculated and compared TTP for EGFR-positive and EGFR-negative patients; however, mutational status was unknown for 77% of the study population. Table VI summarizes ttp with second-line erlotinib therapy in populations of interest. Figure 2 compares median second-line ttp values for the populations of interest mentioned here.

Bottom Line: Although the 3 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.In the third-line setting, in which most patients received docetaxel, the mean ttp was 4.3 months and the overall response rate was 18% (all being partial responses).Subgroup analysis showed that all patient subgroups demonstrated benefit from second-line erlotinib treatment; improved benefit was observed in patients who developed rash, in female patients, in never smokers, in Asian patients, in patients with positive EGFR status, and in patients with adenocarcinoma histology.

View Article: PubMed Central - PubMed

Affiliation: BC Cancer Agency, Vancouver, BC. BMelosky@bccancer.bc.ca

ABSTRACT

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 3 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 in clinical practice of using second-line erlotinib followed by third-line chemotherapy in the treatment of recurrent metastatic NSCLC.

Methods: We conducted a retrospective review of nsclc patient charts at three Canadian institutions. Patients with recurrent nsclc who had received second-line erlotinib therapy followed by third-line chemotherapy were selected by census. A chart review assessed key outcomes that included time to progression (TTP), response, and change in performance status. Outcomes for specific patient subgroups were also examined.

Results: We identified 35 patients for this retrospective 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 1 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 being partial responses). In the third-line setting, in which most patients received docetaxel, the mean ttp was 4.3 months and the overall response rate was 18% (all being partial responses). Subgroup analysis showed that all patient subgroups demonstrated benefit from second-line erlotinib treatment; improved benefit was observed in patients who developed rash, in female patients, in never smokers, in Asian patients, in patients with positive EGFR status, and in patients with adenocarcinoma histology.

Conclusions: For patients with advanced nsclc who progressed following first-line platinum-based chemotherapy, the data demonstrate that second-line EGFR-TKI treatment is efficacious and well-tolerated and that it does not appear to diminish the benefit of third-line chemotherapy.

No MeSH data available.


Related in: MedlinePlus