Yu Shufei, Wang Yan, Li Junling, Hao Xuezhi, Wang Bin, Wang Ziping, Zhang Xiangru, Shi Yuankai
Department of Medical Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Thorac Cancer. 2013 May;4(2):109-116. doi: 10.1111/j.1759-7714.2012.00152.x.
The optimal strategy was not established for patients who initially responded to gefitinib although re-administration of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) has been proven to be an option. Gefitinib and erlotinib were compared as salvage treatment after gefitinib failure.
Thirty-eight lung adenocarcinoma patients were analyzed retrospectively as they received the second EGFR-TKIs treatment with either gefitinib or erlotinib. All of them had obtained disease control from initial gefitinib. Sixteen patients received gefitinib (G-G group) and 22 patients received erlotinib (G-E group).
Of all patients, progress free survival (PFS) and overall survival (OS) were three and 12 months, respectively, and the disease controlled rate (DCR) of the second EGFR-TKIs treatment was 52.6%. One patient (6.3%) had partial remission (PR) and 10 (62.5%) had stable disease (SD), in the G-G group, whereas, three (13.6%) had PR and six (27.2%) had SD, in the G-E group. There was no statistical significance observed, although the DCR in the G-G group was higher than that in G-E group (68.8% vs. 40.8%, P= 0.09). Adverse events of both gefitinib and erlotinib were mild and administered. The median PFS and OS in G-G and G-E groups were similar (PFS four vs. three months; OS 22 vs. 12 months). In multivariate analysis, patients with SD in initial gefitinib treatment had significantly longer OS (P= 0.04).
Gefitinib as well as erlotinib could be an option for patients who benefited from prior gefitinib treatment. Patients with SD in initial gefitinib obtained a significantly longer OS than those with PR.
对于最初对吉非替尼有反应的患者，尽管再次使用表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKIs）已被证明是一种选择，但尚未确立最佳策略。在吉非替尼治疗失败后，对吉非替尼和厄洛替尼作为挽救治疗进行了比较。
回顾性分析了38例肺腺癌患者，他们接受了吉非替尼或厄洛替尼的第二次EGFR-TKIs治疗。所有患者最初使用吉非替尼均获得了疾病控制。16例患者接受吉非替尼治疗（G-G组），22例患者接受厄洛替尼治疗（G-E组）。
所有患者的无进展生存期（PFS）和总生存期（OS）分别为3个月和12个月，第二次EGFR-TKIs治疗的疾病控制率（DCR）为52.6%。G-G组中1例患者（6.3%）部分缓解（PR），10例患者（62.5%）疾病稳定（SD）；而G-E组中3例患者（13.6%）PR，6例患者（27.2%）SD。尽管G-G组的DCR高于G-E组（68.8%对40.8%，P = 0.09），但未观察到统计学意义。吉非替尼和厄洛替尼的不良事件均较轻且可耐受。G-G组和G-E组的中位PFS和OS相似（PFS：4个月对3个月；OS：22个月对12个月）。多因素分析显示，初始吉非替尼治疗为SD的患者OS显著更长（P = 0.04）。
吉非替尼和厄洛替尼均可作为先前从吉非替尼治疗中获益患者的选择。初始吉非替尼治疗为SD的患者OS显著长于PR患者。
