Salvage treatment with erlotinib after gefitinib failure in advanced non-small-cell lung cancer patients with poor performance status: A matched-pair case-control study.

PURPOSE: Gefitinib plays an important role in non-small-cell lung cancer (NSCLC) treatment; however, progression of the disease occurs in most patients even after an initial response. The role of erlotinib after gefitinib failure has been investigated but continues to be debated, especially in heavily treated patients with poor performance status (PS). Therefore, a retrospective matched-pair case-control study was carried out to evaluate the role of erlotinib after gefitinib failure in advanced NSCLC patients.
METHODS: A total of 58 patients were identified. The two groups were balanced with demographic and baseline clinical characteristics. All patients had PS ≥2 and most of them (89.7%) had received more than two systemic therapies before erlotinib or best supportive care (BSC). The epidermal growth factor receptor (EGFR) and KRAS genotypes were analyzed in 36 (62.1%) patients, 19 of them were in the erlotinib group.
RESULTS: Median overall survival (OS) for all patients was 6 months. Median OS for patients who received erlotinib and BSC was 10 and 3 months, respectively (P= 0.001). Disease control rate (DCR) and objective response rate (ORR) were 51.7% and 10.3% in patients receiving erlotinib, respectively, while median time to progression (TTP) was 3 months. Among the 19 patients in the erlotinib group with biomarker results available, those with EGFR mutation achieved longer median TTP (P= 0.016) and better DCR (P= 0.177) than those with wild-type EGFR.
CONCLUSIONS: A switch to erlotinib after gefitinib failure may represent a better therapeutic option for advanced NSCLC patients with poor PS, and an EGFR mutation seemed to be associated with better survival rate.