Efficacy of salvage chemotherapy in the advanced non-small cell lung cancer patients who failed the treatment of chemotherapy and EGFR-TKI.
- Author:
Yun FAN
1
;
Zhi-yu HUANG
;
Hai-feng YU
;
Lü-hong LUO
Author Information
- Publication Type:Clinical Trial
- MeSH: Adult; Aged; Antimetabolites, Antineoplastic; adverse effects; therapeutic use; Antineoplastic Agents; adverse effects; therapeutic use; Antineoplastic Combined Chemotherapy Protocols; therapeutic use; Carcinoma, Non-Small-Cell Lung; drug therapy; pathology; Disease-Free Survival; Erlotinib Hydrochloride; Female; Follow-Up Studies; Glutamates; adverse effects; therapeutic use; Guanine; adverse effects; analogs & derivatives; therapeutic use; Humans; Lung Neoplasms; drug therapy; Male; Middle Aged; Neoplasm Staging; Neutropenia; chemically induced; Pemetrexed; Platinum; administration & dosage; Protein Kinase Inhibitors; therapeutic use; Quinazolines; therapeutic use; Receptor, Epidermal Growth Factor; antagonists & inhibitors; therapeutic use; Remission Induction; Salvage Therapy; Taxoids; adverse effects; therapeutic use; Treatment Failure
- From: Chinese Journal of Oncology 2010;32(11):859-863
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVEEpidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) such as gefitinib and erlotinib are used as standard 2(nd)/3(rd) line therapy in previously treated advanced non-small cell lung cancer (NSCLC). However, the optimal treatment for patients who experienced disease progression after chemotherapy and EGFR-TKI is unclear. The aim of this study was to explore the efficacy and safety of a salvage chemotherapy in advanced NSCLC patients who failed the previous treatment of platinum-based chemotherapy and EGFR-TKI.
METHODSClinicopathological data of 55 cases of advanced NSCLC patients who failure of first-line platinum-based chemotherapy and subsequent treatment with TKI were collected and analyzed. The patients were of PS = 0-2, and with normal vital organ function. Patients received salvage chemotherapy until disease progression or unacceptable toxicity or the patient refused to continue receiving treatment. A chart review assessed the key outcomes including the objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS).
RESULTSFifty-five patients were enrolled in this study from march 2007 to october 2009. The median age of patients was 55 years (range: 34 - 72), 60.0% were males, PS 0-1 patients were 65.5%, stage IV patients were 100%; 34.5% had a TKI treatment duration ≥ 6 months. Twenty-four patients received pemetrexed as salvage chemotherapy, 21 received docetaxal and 10 had other chemotherapy. All patients were evaluable for efficacy. Among them, 7 (12.7%) patients achieved PR, 21 (38.2%) patients SD, and 27 (49.1%) patients PD, with ORR of 12.7% and DCR of 50.9%. The median follow-up duration was 5.5 months, and the median PFS was 2.0 months. The ORR and PFS were not significantly related with gender, PS and chemotherapy regimens (all P > 0.05), but patients with EGFR-TKI treatment ≥ 6 months achieved a significantly better ORR and DCR than those < 6 months (ORR: 21.1% vs. 8.3%, P = 0.012; DCR: 73.3% vs. 38.9%, P = 0.017), mPFS was significant longer in the patients received ≥ 6 months of EGFR-TKI (4.5 vs. 2.0 months, P = 0.008). The toxicity was acceptable and there were no treatment-related deaths.
CONCLUSIONAdvanced NSCLC patients failed with the previous treatment of first-line platinum-based chemotherapy and EGFR-TKI may benefit from salvage chemotherapy, especially in patients who received ≥ 6 months of EGFR-TKI. The toxicity of the salvage chemotherapy is acceptable.
