Gefitinib ('Iressa', ZD1839) is an orally active epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor that has demonstrated antitumour activity and favourable tolerability in Phase II studies. We investigated whether EGFR expression levels could predict for response to gefitinib in patients with advanced non-small-cell lung cancer (NSCLC), who received gefitinib (250 mg day À1 ) as part of a worldwide compassionate-use programme. Tissue samples were analysed by immunohistochemistry to assess membrane EGFR immunoreactivity. Of 147 patients enrolled in our institution, 50 patients were evaluable for assessment of both clinical response and EGFR expression. The objective tumour response rate was 10% and disease control was achieved in 50% of patients. Although high EGFR expression was more common in squamous-cell carcinomas than adenocarcinomas, all objective responses were observed in patients with adenocarcinoma. Response and disease control with gefitinib were not associated with high EGFR expression. Overall, median survival was 4 months, and the 1-year survival rate was 18%. Strong EGFR staining correlated with shorter survival time for all patients. Gefitinib demonstrated promising clinical activity in this group of patients with NSCLC. These results have also shown that EGFR expression is not a significant predictive factor for response to gefitinib.

FDG-PET assessment after 2 days of erlotinib could be useful to identify early resistant patients and to predict survival in unselected NSCLC pretreated population.

The 3-week schedule has similar DI to the 4-week schedule. However the 3-week regimen has a better compliance profile and a comparable response rate in NSCLC, supporting the use of such a schedule.

Gefitinib has promising activity with a good toxicity profile in patients with progressive NSCLC who have received one or two prior chemotherapy regimens. A possible relationship within response and EGFR1 expression is suggested.

This review examines the incidence and implications of overwhelming infection in patients who have undergone splenectomy following trauma.Few topics have been so widely discussed in the last 10 years as the treatment of splenic trauma. Although splenectomy was considered the treatment of choice until recently, it is now held responsible for the onset of overwhelming postsplenectomy infection (OPSI) immediately or many years after surgery'.A large number of experimental and clinical studies from all over the world have contributed to our understanding of the physiology of the spleen and its role in the immunological defence against bacterial Several alternatives to splenectomy (non-operative treatment, splenic embolization, ligation of the splenic artery, splenorrhaphy, partial splenectomy, spleen autotransplantation) have been suggested and adopted after careful experimental studies5-'. Far from clarifying the ideal treatment for splenic trauma, the great mass of data render the choice of surgical treatment even more confusing. This is mainly due to failure to define the precise incidence of OPSI after splenectomy for trauma. The aim of this review is to stimulate a rational approach to resolve these problems. Definition of OPSIAlthough it is believed that Morris and Bullock were the first to hypothesize a n increased incidence of infection after splenectomy in 19199, it was not until 1952 that OPSI became seriously considered. In fact in that year King and Shumacker reported that two of five children who underwent splenectomy for spherocytosis died from the sudden onset of OPSI1o.The onset is sudden, the patient presenting with nausea, vomiting and mental confusion. He then goes into a coma and death occurs within a few hours of the onset of symptoms. Disseminated intravascular coagulation, severe hypoglycaemia, electrolyte imbalance and shock are frequently associated with OPSI'4. In our view, this clinical picture should be present when OPSI is diagnosed. On the contrary many authors have included under the heading OPSI other pathologies, such as subphrenic abscesses and laparotomy wound infections. These are related to the trauma but we d o not think that they should be part ofthe OPSI syndrome as they are not 'specific' septic events linked to splenectomy. In fact, they can also be observed after trauma to the liver, pancreas and especially to the large bowel.It is not easy t o give a precise evaluation of the incidence of OPSI despite the wealth of published information. In our opinion an exact definition of OPSI must be established, especially in the immediate postoperative period as fever, leucocytosis and pulmonary infections frequently occur also after other types of surgery. It is also vital to differentiate between data concerning OPSI incidence and mortality rate inThe clinical picture of OPSI is generally patients splenectomized for splenic trauma and those operated on because of haematological diseases. Incidence of OPSIO'Neal and McDonald reported 256 adults who had undergone ~plenectomy'~; 187 of...