Second-Line Treatments in Non-small Cell Lung Cancer

Tassinari, Davide; Scarpi, Emanuela; Sartori, Sergio; Tamburini, Emiliano; Santelmo, Carlotta; Tombesi, Paola; Lazzari-Agli, Luigi

doi:10.1378/chest.08-1503

Cited by 31 publications

(10 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, information about patients' QOL is mostly limited to one line of treatment (predominantly 1st (Belani et al , 2006; Gebbia et al , 2010) and 2nd line CT (Dancey et al , 2004; Tassinari et al , 2009)). Although multiple lines of CT are often part of a comprehensive treatment concept, changes in patients' health status from one line to another are rarely investigated (Socinski et al , 2002).…”

mentioning

confidence: 99%

Quality of life during chemotherapy in lung cancer patients: results across different treatment lines

et al. 2013

View full text Add to dashboard Cite

Background:Most lung cancer patients are diagnosed at an advanced disease stage and predominantly receive palliative treatment, which increasingly consists of several chemotherapy lines. We report on patients' quality of life (QOL) to gain knowledge on QOL during and across multiple lines of chemotherapy. This includes patients with (neo)adjuvant therapy up to 3rd or above line palliative chemotherapy.Methods:Lung cancer patients receiving outpatient chemotherapy at the Kufstein County Hospital completed an electronic version of the EORTC QLQ-C30. Linear mixed models were used for statistical analysis.Results:One hundred and eighty seven patients were included in the study. Surprisingly, irrespective of the chemotherapy line patients reported stable QOL scores during treatment. None of the calculated monthly change rates attained clinical significance, referring to established guidelines that classify a small clinical meaningful change as 5 to 10 points. According to treatment line, 3rd or above line palliative chemotherapy was associated with the worst QOL scores, whereas patients undergoing (neo)adjuvant or 1st line palliative chemotherapy reported fairly comparable QOL.Conclusion:The essential finding of our study is that all QOL aspects of the EORTC QLQ-C30 questionnaire remained unchanged during each chemotherapy line in an unselected population of lung cancer patients. Between treatment lines pronounced differences were found, indicating that later palliative chemotherapy lines are associated with higher QOL impairments. These changes in QOL may not primarily be related to the treatment, but rather refer to impairments due to disease progression and may be partly due to a consequence of the prior therapies.

show abstract

mentioning

confidence: 99%

Quality of life during chemotherapy in lung cancer patients: results across different treatment lines

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Numerous clinical trials have been developed to evaluate the efficacy of erlotinib in the treatment of advanced NSCLC, either in combination with chemotherapy or alone; however, consistent results have not been identified, and our meta analysis showed that erlotinib combined with CT could increase PFS and objective response rate, but not benefit OS, 9 our another meta analysis disclosed that erlotinib could decrease the incidence of neutropenia and leukopenia in patients with advanced NSCLC undergoing erlotinib regardless of whether combined with CT or not. 10 In recent years, many published meta-analyses have been focusing on EGFR-TKIs for NSCLC 11 – 14 ; however, all 4 studies explored a combination of EGFR-TKIs rather than the effects of single agent. However, some studies reported different antitumor activities and favorable toxicities for various oral EGFR-TKIs.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Erlotinib Versus Conventional Chemotherapy for Advanced Nonsmall-Cell Lung Cancer

Tian

Zeng

et al. 2016

Medicine

View full text Add to dashboard Cite

Non-small-cell lung cancer (NSCLC) is the leading cause of cancer deaths. Erlotinib is the first-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), the National Comprehensive Cancer Network (NCCN) guidelines recommend it as a first-line agent in patients with sensitizing EGFR mutations.We conducted a meta-analysis to compare the efficacy of erlotinib and chemotherapy for advanced NSCLC, and evaluated the efficacy of them to provide references for further clinical practice and research.PubMed, EMBASE, CBM, CNKI, WanFang database, The Cochrane library, and Web of Science, as well as abstracts presented at ASCO conferences and ClinicalTrials.gov were searched to identify relevant studies. HR with 95% confidence intervals (CIs) for progression-free survival (PFS) and overall survival (OS), relative risk (RR) with 95% CIs for objective response rate (ORR) and 1-year survival rate (OSR) were all extracted. If the I2 was ≤40%, then the trial was considered to be heterogeneous, and a fixed-effects model was selected. Otherwise, a random-effects model was used. Meta-regression and sensitivity analyses were conducted to determine the possible heterogeneity causes and to further identify the influence of the various exclusion criteria on the overall risk estimate.The pooled analysis demonstrated a PFS HR of 0.93 (95% CI = 0.73, 1.19) for erlotinib versus chemotherapy and an ORR of 18.43% versus 22.07%, respectively. The OS HR was 1.02 (95%CI = 0.93, 1.12). The HRs for PFS estimated based on 10 trials involving 1101 patients were 0.22 (95% CI = 0.15, 0.29) and 1.27 (95% CI = 1.04, 1.48) in EGFR mutation-type and wild-type patients, respectively. The HRs for OS calculated from 4 studies including 681 participants were 0.83 (95% CI = 0.61, 1.05) and 0.86 (95% CI = 0.68, 1.04) in EGFR mutation-type and wild-type patients, respectively. The 1-year survival rates were 31.31% and 32.41%, respectively.Overall, the present meta-analysis suggested that erlotinib did not improve the ORR, PFS, OS or the 1-year survival rate for whole patients. However, erlotinib could benefit patients with EGFR mutation in terms of PFS, but the OS does not benefit from it for these patients. Further studies of erlotinib for these subgroup patients are warranted.

show abstract

“…The advent of the continuum maintenance strategy with pemetrexed or bevacizumab has further improved the survival outcomes of patients with adenocarcinoma histology, reaching a new plateau of about 14–16 months [5–7], while fewer options remain available for patients with squamous cell lung cancer. Unfortunately all NSCLC patients develop acquired resistance within 6–10 months of treatment, with only 20% and 8% of all diagnosed population being able to tolerate second- and third-line therapy, respectively [8]. …”

Section: Introductionmentioning

confidence: 99%

The comparison of outcomes from tyrosine kinase inhibitor monotherapy in second- or third-line for advanced non-small-cell lung cancer patients with wild-type or unknown EGFR status

Bronte

Franchina

Alù³

et al. 2016

Oncotarget

View full text Add to dashboard Cite

BackgroundSecond-line treatment for advanced non-small-cell lung cancer (NSCLC) patients includes monotherapy with a third-generation cytotoxic drug (CT) or a tyrosine kinase inhibitor (TKI). These options are the actual standard for EGFR wild-type (WT) status, as patients with EGFR mutations achieve greater benefit by the use of TKI in first-line treatment. Some clinical trials and meta-analyses investigated the comparison between CT and TKI in second-line, but data are conflicting.MethodsWe designed a retrospective trial to gather information about TKI sensitivity in comparison with CT. We selected from clinical records patients treated with at least 1 line of CT and at least 1 line of TKI. We collected data about age, sex, performance status, comorbidity, smoking status, histotype, metastatic sites, EGFR status, treatment schedule, better response and time-to-progression (TTP) for each line of treatment and overall survival (OS).Results93 patients met selection criteria. Mean age 66,7 (range: 46–84). M/F ratio is 3:1. 39 EGFR-WT and 54 EGFR-UK. All patients received erlotinib or gefitinib as second-line treatment or erlotinib as third-line treatment. No TTP differences were observed for both second-line (HR:0,91; p = 0,6333) and third-line (HR:1.1; p = 0,6951) treatment (TKI vs CT). A trend of a benefit in OS in favor of 3rd-line TKI (HR:0,68; p = 0,11).ConclusionsThis study explores the role of TKIs in EGFR non-mutated NSCLC patients. OS analysis highlights a trend to a benefit in patients who received TKI in third-line, even if this result is statistically non-significant. Further analysis are needed to find an explanation for this observation.

show abstract

Second-Line Treatments in Non-small Cell Lung Cancer

Cited by 31 publications

References 44 publications

Quality of life during chemotherapy in lung cancer patients: results across different treatment lines

Quality of life during chemotherapy in lung cancer patients: results across different treatment lines

The Efficacy of Erlotinib Versus Conventional Chemotherapy for Advanced Nonsmall-Cell Lung Cancer

The comparison of outcomes from tyrosine kinase inhibitor monotherapy in second- or third-line for advanced non-small-cell lung cancer patients with wild-type or unknown EGFR status

Contact Info

Product

Resources

About