Clinical Analysis of 17 Cases Beginning Treatment with Erlotinib the Day After Terminating Gefitinib for Advanced Non-small Cell Lung Cancer

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Background. Both gefitinib and erlotinib are orally-administered reversible epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) used in the treatment for advanced non-small cell lung cancer (NSCLC). Erlotinib has a disease control rate of 30% for NSCLC which acquired resistance to gefitinib. However, it is not known whether erlotinib has any clinical benefit for patients who experienced disease progression with gefitinib. We previously reported the effectiveness of readministration of gefitinib in 24 patients with recurrent NSCLC who had already been treated with gefitinib. We considered that the effectiveness is mainly associated with the regrowth of EGFR-TKI sensitive cells during the TKI-free interval. We retrospectively examined 17 cases beginning treatment with erlotinib the next day after terminating gefitinib. There are no reports concerning only cases with no TKI-free interval. Materials and Methods. The study included advanced or recurrent NSCLC patients who had received one or more chemotherapy regimens and subsequent gefitinib monotherapy, or gefitinib as first line treatment. We started treatment with erlotinib the day after terminating gefitinib. We retrospectively examined 17 cases for responses and time to treatment failure. Results. Patients characteristics were as follows: female/male: 9/8; median age: 70 years (56-83); smoking status, never/former: 9/8; all cases were adenocarcinoma; positive/negative EGFR mutation was 14/3; stages and recurrence cases were IIIB/IV/recurrent: 2/9/6; the number of prior chemotherapy treatment were 0/1/2/3/4/5: 3/6/5/2/0/1. No patients obtained partial response, stable disease was observed in 9 patients, with improvement of multiple brain metastasis in 4 cases. The median times to treatment failure were 160 days (53-350). On the other hand, 7 of 8 cases having progressive disease with erlotinib had EGFR major mutation (exon 19 deletion or exon 21 L858R), good response with a long duration to prior gefitinib therapy. Conclusions. Erlotinib seems to be a potential therapeutic option for advanced NSCLC after gefitinib failure. In particular, a change to erlotinib may be beneficial for patients who do not have good response to gefitinib therapy or have central nerve lesions.

Clinical Analysis of 17 Cases Beginning Treatment with Erlotinib the Day After Terminating Gefitinib for Advanced Non-small Cell Lung Cancer

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