Clinical surrogate markers of survival in advanced non-small cell lung cancer (NSCLC) patients treated with second–third line erlotinib

Cedrés, S.; Prat, Aleix; Martı́nez, Pablo; Pallisa, Esther; Sala, Gemma Laguillo; Andreu, Jordi; Campo, J.M. del; Quispe, Isela; Baselga, José; Felip, Enriqueta

doi:10.1016/j.lungcan.2009.01.014

Cited by 18 publications

(12 citation statements)

References 24 publications

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“…Another possible reason is that patients with NSCLC who are highly sensitivetoerlotinibmayhaveinherentfactorsthatareassociated with better effects of erlotinib. Several clinical surrogate markers and molecular markers of survival in NSCLC patientstreatedwitherlotinibhavebeenreported [7,13].In thisstudy,wealsocomparedbaselinefactorsinthedosereduction and non-dose reduction groups. The dose reduction groupcomprisedsignificantlymorepatientswhowerefemale, had an EGFR gene mutation, had no smoking history, and hadgrade3skinrash.Previousstudieshaveshownthatthese factorsarestronglyassociatedwiththeeffectsoferlotinib [7,13].Thereisthepossibilitythaterlotinib-relatedskinrashand otherfactorsarestronglycorrelatedwitheachother,although it remains unclear which of these factors is the most significantprognosticmarker.…”

Section: Discussionmentioning

confidence: 99%

Prognosis in Patients with Non-Small Cell Lung Cancer Who Received Erlotinib Treatment and Subsequent Dose Reduction due to Skin Rash

Takashima¹,

Kimura

Watanabe

et al. 2012

Onkologie

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Background: Severe skin rash as toxicity of erlotinib has been reported in relation to better response and survival. However, some patients require dose reduction due to skin toxicities, and their prognosis remains uncertain. We retrospectively evaluated the clinical course of non-small cell lung cancer patients receiving erlotinib at a reduced dose because of skin rash. Patients and Methods: Among 76 patients treated with erlotinib, 55 patients who developed skin rash severer than grade 2 were divided into 2 groups: 24 patients treated with erlotinib with dose reduction because of skin rash (dose reduction group) and 31 patients without any dose reduction (non-dose reduction group). Results: The median progression-free survival in the dose reduction and non-dose reduction groups was 341 and 70 days, respectively, and the median overall survival was 566 and 202 days, respectively (p < 0.001). In the dose reduction group, no smoking history, female sex, epidermal growth factor receptor gene mutation, and grade 3 skin rash were significant baseline factors. Conclusions: Patients who received erlotinib at a reduced dose following skin rash showed better survival than those without reduction. In cases of intolerable skin rash, patients may benefit from continuous treatment with a reduced dose of erlotinib.

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Section: Discussionmentioning

confidence: 99%

Prognosis in Patients with Non-Small Cell Lung Cancer Who Received Erlotinib Treatment and Subsequent Dose Reduction due to Skin Rash

Takashima¹,

Kimura

Watanabe

et al. 2012

Onkologie

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“…Although stronger skin rashes are associated with a favorable efficacy in erlotinib therapy (24,25), intolerable skin rashes occasionally develop. To relieve this and other intolerable toxicities, dose reduction is conventionally performed in many situations.…”

Section: Discussionmentioning

confidence: 99%

Dose Reduction or Intermittent Administration of Erlotinib: Which Is Better for Patients Suffering from Intolerable Toxicities?

et al. 2013

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Erlotinib is an epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor that is widely used in the treatment of non-small cell lung cancer. Skin rashes and diarrhea are frequent side effects of erlotinib therapy. When these toxicities become intolerable, dose reduction is commonly performed. However, dose reduction may not maintain the effective dose levels in some specific situations, such as in cases of wild-type EGFR tumors or central nervous system metastases. We speculate that intermittent administration is better than dose reduction to simultaneously maintain the effective dose levels and reduce toxicities in such situations. We herein present four cases of patients who successfully received intermittent administration of erlotinib.

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“…Patients were classified as follows, similarly as previously reported [16]: current or active smoker if the subject continued smoking at the beginning of second-line therapy or had stopped less than 6 months ago; former smoker if the subject had ever smoked but stopped more than 6 months ago, and never-smoker if the subject had never smoked. Each patient was classified according to the data documented in the medical records.…”

Section: Methodsmentioning

confidence: 99%

Erlotinib versus Pemetrexed for Pretreated Non-Squamous Non-Small Cell Lung Cancer Patients in Clinical Practice

Zugazagoitia¹,

Puente²,

González-Larriba³

et al. 2013

Oncology

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Background/Aim: Erlotinib and chemotherapy have shown similar efficacy for pretreated non-small cell lung cancer (NSCLC) patients, but none of the large studies have selected patients based on histology. We present a retrospective single-center series of advanced non-squamous NSCLC patients treated with erlotinib or pemetrexed as second-line therapy. Our aim was to compare the efficacy and safety data under clinical practice conditions and to identify subgroups of patients who could benefit more from these therapies. Methods: A total of 88 patients were included. Squamous histology was our main exclusion criterion. EGFR mutation status was known for 54.5% of the patients; 6 patients treated with erlotinib and 2 with pemetrexed had EGFR-mutated tumors. Smoking history was analyzed as possible predictive factor of efficacy. Results: No significant differences in progression-free survival (PFS; 3 vs. 2.5 months, p = 0.06) or overall survival (OS; 4.9 vs. 7.4 months, p = 0.733) between the erlotinib and pemetrexed groups were found in the overall population. EGFR wild-type patients had a similar median PFS with erlotinib compared to pemetrexed (2.7 vs. 2.3 months, p = 0.42), with no statistical differences in OS. Statistically significant differences in OS in favor of pemetrexed for current smokers (3 vs. 7.1 months, p = 0.017) were found, while erlotinib achieved significantly better PFS in never-smokers compared to former smokers (3.5 vs. 2.7 months, p = 0.005). Serious adverse events were uncommon but more frequent with pemetrexed, and were mainly related to hematologic toxicity. Conclusions: Erlotinib should be considered as another equal option in second-line treatment for EGFR wild-type patients as well as for subpopulations with unknown mutational status. Smoking history could be a useful clinical marker to choose a second-line treatment.

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Clinical surrogate markers of survival in advanced non-small cell lung cancer (NSCLC) patients treated with second–third line erlotinib

Cited by 18 publications

References 24 publications

Prognosis in Patients with Non-Small Cell Lung Cancer Who Received Erlotinib Treatment and Subsequent Dose Reduction due to Skin Rash

Prognosis in Patients with Non-Small Cell Lung Cancer Who Received Erlotinib Treatment and Subsequent Dose Reduction due to Skin Rash

Dose Reduction or Intermittent Administration of Erlotinib: Which Is Better for Patients Suffering from Intolerable Toxicities?

Erlotinib versus Pemetrexed for Pretreated Non-Squamous Non-Small Cell Lung Cancer Patients in Clinical Practice

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