Initial Progression-Free Survival after Non-First Line TKIs Therapy Potentially Guides Immediate Treatment after Its Failure in Advanced Non-Small Cell Lung Cancer

摘要

Objective The standard therapy after failure of the initial non-first line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment in advanced non-small cell lung cancer(NSCLC) has not yet been established.The aim of the current study was to identify whether the 2 TKI treatment or chemotherapy(paclitaxel-containing or non-paclitaxel regimen) is the appropriate treatment for patients with NSCLC based on the efficacy of the initial TKIs. Methods Seventy-two advanced NSCLC patients who had accepted 2 TKIs or chemotherapy immediately after failure of the initial TKIs in non-first line setting from May 1,2004 to January 31,2010 at the Sun Yat-sen University Cancer Center were enrolled.The primary endpoint[2 progression-free survival(PFS)]and the second endpoint[overall survival(OS)]were compared among the 2 TKI and chemotherapy groups as well as their subgroups. Results(1) Twenty-one patients were treated with 2 TKIs,and 51 patients were administered chemotherapy after failure of the initial non-first line TKI treatment.There was nonsignificant difference in the responses(P=0.900)[2 PFS(P=0.833) and OS(P=0.369)] between the 2 TKI and chemotherapy groups.(2) In the 2 TKI group,9 patients exhibited PFS>7 months.The initial TKI treatment group exhibited a longer 2 PFS than the other 12 patients with an initial PFS 5 months in the initial TKI treatment(3 months vs.2 months,P=0.039).(4) In the chemotherapy group, patients treated with paclitaxel-containing regimen showed longer 2 PFS than those treated with non-paclitaxel regimen(5 months vs.2.3 months,P=0.043). Conclusions Patients with PFS>7 months or <5 months under the initial TKI treatment potentially benefit from the 2 TKI treatment or chemotherapy immediately after failure of the non-first line TKIs.The paclitaxel-containing regimen may improve the 2 PFS. However,more patient samples are urgently needed to validate these findings.