Early or Late Gefitinib, Which is Better for Survival? - Retrospective Analysis of 228 Korean Patients with Advanced or Metastatic NSCLC
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background The optimal timing of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI) in NSCLC patients has not yet been determined. Methods We separated 228 patients with advanced/metastatic NSCLC treated with gefitinib into an early gefitinib group (patients who received gefitinib as first- or second-line treatment) and a delayed gefitinib group (patients who received gefitinib as third or fourth-line treatment) and attempted to determine whether the timing of gefitinib treatment affected clinical outcomes. Results Median overall survival (OS), progression free survival (PFS), and median OS from first-line treatment of advanced/metastatic disease (OSt) for 111 patients in the early gefitinib group were 6.2 months, 3.3 months, and 11.6 months. However, median OS, PFS, and OSt for 84 patients in the delayed gefitinib group were 7.8 months, 2.3 months, and 22.7 months. No differences in OS and PFS were observed between the 2 groups. However, OSt was significantly longer in the delayed gefitnib group. Timing of gefitinib therapy was one of the independent predictors of OSt. Hb ≥ 10 g/dl, and having never smoked, and ECOG performance status ≤1 were independent predictors of better PFS. Conclusion Deferral of gefitinib therapy in patients with advanced or metastatic NSCLC may be preferable if they are able to tolerate chemotherapy.
Abstract
Background The optimal timing of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI) in NSCLC patients has not yet been determined. Methods We separated 228 patients with advanced/metastatic NSCLC treated with gefitinib into an early gefitinib group (patients who received gefitinib as first- or second-line treatment) and a delayed gefitinib group (patients who received gefitinib as third or fourth-line treatment) and attempted to determine whether the timing of gefitinib treatment affected clinical outcomes. Results Median overall survival (OS), progression free survival (PFS), and median OS from first-line treatment of advanced/metastatic disease (OSt) for 111 patients in the early gefitinib group were 6.2 months, 3.3 months, and 11.6 months. However, median OS, PFS, and OSt for 84 patients in the delayed gefitinib group were 7.8 months, 2.3 months, and 22.7 months. No differences in OS and PFS were observed between the 2 groups. However, OSt was significantly longer in the delayed gefitnib group. Timing of gefitinib therapy was one of the independent predictors of OSt. Hb ≥ 10 g/dl, and having never smoked, and ECOG performance status ≤1 were independent predictors of better PFS. Conclusion Deferral of gefitinib therapy in patients with advanced or metastatic NSCLC may be preferable if they are able to tolerate chemotherapy.
참고문헌 (26)
- Mendelsohn J, "Targeting the epidermal growth factor receptor for cancer therapy", J Clin Oncol, 20(18 Suppl), pp.1S~13S (2002)
- "J Clin Oncol", 2003, 2237~2246
- Kris MG, "Efficacy of gefitinib, an inhibitor of the epidermal growth factor receptor tyrosine kinase in symptomatic patients with non-small cell lung cancer: a randomized trial", JAMA, 290, pp.2149~2158 (2003)
- Thatcher N, "Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer)", Lancet, 366, pp.1527~1537 (2005)
- Perez-Soler R, "Determinants of tumor response and survival with erlotinib in patients with non-small-cell lung cancer", J Clin Oncol, 22, pp.3238~3247 (2004)
- Shepherd FA, "Erlotinib in previously treated non-small-cell lung cancer", N Engl J Med, 353, pp.123~132 (2005)
- Shah NT, "Practical management of patients with non-small-cell lung cancer treated with gefitinib", J Clin Oncol, 23, pp.165~174 (2005)
- Niho S, "First-line single agent treatment with gefitinib in patients with advanced non-small-cell lung cancer: a phase II study", J Clin Oncol, 24, pp.64~69 (2006)
- Lin WC, "Gefitinib as front-line treatment in Chinese patients with advanced non-small- cell lung cancer", Lung Cancer, 54, pp.193~199 (2006)
- Lee DH, "The role of gefitinib treatment for Korean never-smokers with advanced or metastatic adenocarcinoma of the lung: a prospective study", J Thorac Oncol, 1, pp.965~971 (2006)
- Lee DH, "Gefitinib as a first-line therapy of advanced or metastatic adenocarcinoma of the lung in never-smokers", Clin Cancer Res, 11, pp.3032~3037 (2005)
- Inoue A, "Prospective phase II study of gefitinib for chemotherapy-naive patients with advanced non-small-cell lung cancer with epidermal growth factor receptor gene mutations", J Clin Oncol, 24, pp.3340~3346 (2006)
- Lee DH, "Gefitinib is of more benefit in chemotherapy-naive patients with good performance status and adenocarcinoma histology: retrospective analysis of 575 Korean patients", Lung Cancer, 53, pp.339~345 (2006)
- Ferguson MK, "Sex-associated differences in presentation and survival in patients with lung cancer", J Clin Oncol, 8, pp.1402~1407 (1990)
- Bryant A, "Differences in epidemiology, histology, and survival between cigarette smokers and never-smokers who develop non-small cell lung cancer", Chest, 132, pp.185~192 (2007)
- Radzikowska E, "Lung cancer in women: age, smoking, histology, performance status, stage, initial treatment and survival. Population-based study of 20,561 cases", Ann Oncol, 13, pp.1087~1093 (2002)
- Nordquist LT, "Improved survival in never- smokers vs current smokers with primary adenocarcinoma of the lung", Chest, 126, pp.347~351 (2004)
- Albain KS, "Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience", J Clin Oncol, 9, pp.1618~1626 (1991)
- Caro JJ, "Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review", Cancer, 91, pp.2214~2221 (2001)
- Gauthier I, "Impact of hemoglobin levels on outcomes of adjuvant chemotherapy in resected non-small cell lung cancer: the JBR.10 trial experience", Lung Cancer, 55, pp.357~363 (2007)
- Judson I, "Imatinib pharmacokinetics in patients with gastrointestinal stromal tumour: a retrospective population pharma- cokinetic study over time. EORTC Soft Tissue and Bone Sarcoma Group", Cancer Chemother Pharmacol, 55, pp.379~386 (2005)
- Cangir AK, "Prognostic value of tumor size in non-small cell lung cancer larger than five centimeters in diameter", Lung Cancer, 46, pp.325~331 (2004)
- Basaki K, "Prognostic factors for survival in stage III non-small-cell lung cancer treated with definitive radiation therapy: impact of tumor volume", Int J Radiat Oncol Biol Phys, 64, pp.449~454 (2006)
- Greco FA, "Prospective randomized study of four novel chemotherapy regimens in patients with advanced nonsmall cell lung carcinoma: a minnie pearl cancer research network trial", Cancer, 95, pp.1279~1285 (2002)
- Schiller JH, "Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer", N Engl J Med, 346, pp.92~98 (2002)
- Kelly K, "Randomized phase III trial of paclitaxel plus carboplatin versus vinorelbine plus cisplatin in the treatment of patients with advanced non--small-cell lung cancer: a Southwest Oncology Group trial", J Clin Oncol, 19, pp.3210~3218 (2001)