Gefitinib or erlotinib in previously treated non–small-cell lung cancer patients: a cohort study in Taiwan
Journal
Cancer Medicine
Journal Volume
6
Journal Issue
7
Pages
1563-1572
Date Issued
2017
Author(s)
Abstract
Among treatment modalities for lung cancer, the most promising therapy is the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Both erlotinib and gefitinib, the two first-generation EGFR-TKIs, exhibit significant clinical responses for patients with lung adenocarcinoma. However, few studies have compared the effects of these two drugs, and results have been inconclusive because of the small sample sizes in these studies. Therefore, this study was conducted to investigate this issue. This retrospective nationwide cohort study enrolled NSCLC patients who received EGFR-TKIs after previous chemotherapy in Taiwan between 1996 and 2010 from the National Health Insurance Research Database. Clinical response and survival after receiving erlotinib and gefitinib were compared using logistic and Cox regression analyses, respectively. Inverse propensity score weighting and a sensitivity analysis in the EGFR-TKI responder (clinical improvement by taking EGFR-TKIs for 90?days), adherent patients (receiving EGFR-TKI on a daily basis), adenocarcinoma, and adenocarcinoma with second-line TKIs subgroup were performed for bias adjustment. A total of 7222 patients, including 4592 (63.6%) who received gefitinib, were identified. In the survival analysis, erlotinib was associated with a decline in 1-year progression-free survival (PFS) (hazard ratio, HR: 1.15 [1.09–1.21]) and overall survival (OS) (HR: 1.10 [1.03–1.18]). The effects of various TKIs were consistent in the 4939 EGFR-TKI responders, adherent subgroup, adenocarcinoma subgroup, and adenocarcinoma with second-line TKIs subgroup. In previously treated EGFT-TKI-naive NSCLC patients, those receiving gefitinib exhibited a longer PFS and OS than those receiving erlotinib. Additional large-scale randomized controlled trials are warranted to confirm this finding. ? 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
SDGs
Other Subjects
erlotinib; gefitinib; antineoplastic agent; erlotinib; gefitinib; protein kinase inhibitor; quinazoline derivative; adult; age distribution; aged; Article; cachexia; cancer prognosis; cancer survival; cohort analysis; controlled study; disease severity; drug efficacy; erythrocyte transfusion; female; human; length of stay; lowest income group; major clinical study; male; median survival time; medication compliance; non small cell lung cancer; overall survival; patient compliance; priority journal; progression free survival; retrospective study; sex difference; Taiwan; treatment response; treatment withdrawal; comorbidity; Kaplan Meier method; lung tumor; middle aged; molecularly targeted therapy; mortality; non small cell lung cancer; prognosis; propensity score; proportional hazards model; register; retreatment; severity of illness index; treatment outcome; very elderly; Aged; Aged, 80 and over; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Cohort Studies; Comorbidity; Erlotinib Hydrochloride; Female; Humans; Kaplan-Meier Estimate; Lung Neoplasms; Male; Middle Aged; Molecular Targeted Therapy; Prognosis; Propensity Score; Proportional Hazards Models; Protein Kinase Inhibitors; Quinazolines; Registries; Retreatment; Severity of Illness Index; Taiwan; Treatment Outcome
Publisher
Blackwell Publishing Ltd
Type
journal article