Salvage Therapy for Chinese Non-small Cell Lung Cancer Patients Who Failed Previous Chemotherapy

Abstract

Our aim was to determine the appropriate salvage regimen for Chinese non-small cell lung cancer (NSCLC) patients who failed previous chemotherapy. We retrospectively analyzed data from our seven clinical trials, including single-agent gemcitabine, gefitinib, docetaxel with a different schedule, vinorelbine plus cisplatin, vinorelbine plus gemcitabine, docetaxel plus gemcitabine, and docetaxel plus ifosfamide, with a total of 342 cases (including 314 patients, of which 28 entered two different trials due to different salvage line settings), and compared these data with those of other studies, addressing the efficacy and toxicity of salvage therapy in patients who failed previous chemotherapy to analyze choosing of an appropriate salvage regimen. Of the 342 cases receiving salvage treatment, 71.1% were in second-line treatment, and 28.9% in third-line or later treatment. The response rate to our salvage therapy ranged widely, from 6.1% to 36.1%. Median survival was between 5.7 and 8.4 months when different salvage chemotherapy regimens were used, whereas it was 9.3 months in those who received gefitinib treatment. Similarly, 1-year survival ranged between 19.7% and 40% in a chemotherapy setting, and 40.8% for gefitinib treatment. Those who received gefitinib had better toxicity profiles than those who received other regimens. Febrile neutropenia occurred in 19 patients who received a chemotherapy agent (6.2%), and four patients died despite granulocyte colony-stimulating factor and antibiotic treatment. Grade 3 or 4 interstitial pneumonitis occurred in 14 of 247 patients (5.7%) who received docetaxel with/without another agent, and 10 patients died. Grade 3 interstitial pneumonitis occurred in one patient who received gefitinib treatment and recovered. In conclusion, both chemotherapeutic agents, such as docetaxel alone or gemcitabine plus vinorelbine, and gefitinib, are probably appropriate salvage regimens for Chinese NSCLC patients who have failed previous chemotherapy. However, gefitinib has a better safety profile and probably better survival than the chemotherapeutic agents and would be an appropriate alternative choice for salvage chemotherapy, even in a second-line setting for Chinese patients.

Third-line therapy for advanced non-small-cell lung cancer patients: feasible drugs for feasible patients

“…The OS of combination treatment also showed a moderate improvement comparing with mono-chemotherapy in some studies [20,21]. Several studies also indicated that doublet chemotherapy was a feasible treatment, especially for those patients who had a good PS and had administered targeted drugs in first-or second-line treatment [22]. So far, we have not yet found out whether there is continuously increasing PFS for advanced NSCLC with third-line or further-line treatment and improvement in cancer-related symptoms for doublet chemotherapy patients.…”