Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Clin Lung Cancer. 2011 Mar;12(2):116-24. doi: 10.1016/j.cllc.2011.03.006. Epub 2011 Apr 9.
Gefitinib is effective in treating patients with non-small-cell lung cancer (NSCLC). The response rate and improvement in survival are related to several aspects, including race, gender, smoking status, and histology; however, little is known about the relationship between survival and length of gefitinib treatment. We conducted this retrospective study to examine this relationship and identify the predictive factors influencing survival and tumor response in chemonaive and chemotherapy patients who had stage IIIb or IV NSCLC with unknown epidermal growth factor receptor mutants. This analysis was aimed to clarify the difference between first- and second-line gefitinib therapy. Among the 918 newly diagnosed, inoperable NSCLC patients from March 2003 to December 2006, 437 (47.6%) had ever received gefitinib therapy. One hundred forty-nine patients (34.0%) who selected gefitinib as first- or second-line therapy were included in the analysis. The overall survival rates of first- and second-line gefitinib therapy were 12.8 months and 20.7 months, respectively (P = .110). The shorter overall survival may be caused by the omission of platinum-based doublet chemotherapy in 37 patients from the first-line group (39.4%). There was also no significant difference in progression-free survival (6.8 months versus 4.9 months; P = .415), and the objective tumor response and disease control rates were similar. Better prognosis and tumor response was associated with female gender, adenocarcinoma, nonsmokers, and good performance status. The difference in overall survival between patients undergoing second-line treatment compared with those undergoing first-line treatment preceding chemotherapy was significant (P = .041). The overall survival, progression-free survival, and tumor response rates were similar in the patients who received gefitinib as initial therapy or after conventional chemotherapy.
吉非替尼治疗非小细胞肺癌（NSCLC）有效。反应率和生存改善与多种因素相关，包括种族、性别、吸烟状况和组织学；但是，关于生存与吉非替尼治疗时间的关系知之甚少。我们进行了这项回顾性研究，以检查这种关系，并确定在组织学类型未知的表皮生长因子受体突变的 IIIb 期或 IV 期 NSCLC 患者中，与化疗初治和化疗后患者的生存和肿瘤反应相关的预测因素。本分析旨在阐明一线和二线吉非替尼治疗之间的差异。在 2003 年 3 月至 2006 年 12 月期间诊断为不能手术的新发病例的 918 例非小细胞肺癌患者中，437 例（47.6%）曾接受过吉非替尼治疗。在选择吉非替尼作为一线或二线治疗的 149 例患者中，有 100 例（34.0%）患者纳入了本分析。一线和二线吉非替尼治疗的总生存率分别为 12.8 个月和 20.7 个月（P =.110）。在一线组中，有 37 例患者（39.4%）未接受铂类双联化疗，可能导致总生存率缩短。无进展生存期（6.8 个月对 4.9 个月；P =.415）也没有显著差异，客观肿瘤反应和疾病控制率相似。女性、腺癌、非吸烟者和较好的体力状态与更好的预后和肿瘤反应相关。与化疗前接受二线治疗的患者相比，化疗后接受二线治疗的患者的总生存时间差异有统计学意义（P =.041）。在初始接受吉非替尼治疗或在常规化疗后接受吉非替尼治疗的患者中，总生存时间、无进展生存时间和肿瘤反应率相似。
