Recurrence patterns of advanced non-small cell lung cancer treated with gefitinib

• Published in: Chinese medical journal Vol. 126; no. 12; pp. 2235 - 2241
• Main Authors: Chen, Min-Jiang, Zhong, Wei, Zhang, Li, Zhao, Jing, Li, Long-Yun, Wang, Meng-Zhao
• Format: Journal Article
• Language: English
• Published: China Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China 20.06.2013
• Subjects: Adult; Aged; Antineoplastic Agents - therapeutic use; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Disease Progression; Female; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Male; Middle Aged; Neoplasm Recurrence, Local; Protein Kinase Inhibitors - therapeutic use; Quinazolines - therapeutic use; Retrospective Studies; 中枢神经系统; 复发率; 晚期; 治疗; 生存时间; 表皮生长因子受体; 酪氨酸激酶抑制剂; 非小细胞肺癌; non-small cell lung cancer; recurrence; gefitinib
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.20122001

Background Gefitinib is widely used in the treatment of advanced non-small cell lung cancer （NSCLC）.However,only a small number of reports have described initial failure sites in patients treated with gefitinib.The aim of this study was to investigate survival,recurrence sites,and treatment after recurrence in these patients.Methods A retrospective review was conducted of all patients with stage Ⅲ/Ⅳ NSCLC treated with gefitinib in Peking Union Medical College Hospital from October 2002 to September 2011.Patient characteristics,initial failure sites,associated clinical factors,and subsequent therapy were included in the analysis of prognostic factors.Results A total of 316 patients were identified The median progress free survival （PFS） and overall survival （OS） times were 238 days and 468 days,respectively.The median survival time after progression was 145 days.The sites of initial failure were lung （62.34%）,bone （17.72%）,central nerve system （CNS,16.14%）,liver （9.49%）,and others （7.19%）.Patients with single-site progression or multi-site progression were 81.01% and 18.99%,respectively.Progression-free survival time was associated with lung and bone failure.Additionally,the median survival time after progression was lower in patients with multi-site progression and liver progression.Other initial failure sites displayed no relationship with survival,including CNS failure.Subsequent therapy may affect survival after progression.In patients receiving continuous epidermal growth factor receptor tyrosine kinase inhibitor （EGFR-TKI） therapy,chemotherapy,radiotherapy,and retreatment with EGFR-TKIs,survival time after progression was prolonged compared with the best supportive care.Conclusions Our data suggest that patients receiving gefltinib should be closely monitored regarding lung metastasis during follow-up.Liver metastases and multi-site progression were poor prognostic factors.After failure with gefltinib,patients may benefit from radiotherapy,chemotherapy,continuous EGFR-TKI therapy and re-treatment with EGFR-TKIs.