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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2012; 33(03): 146-154
DOI: 10.4103/0971-5851.103141
ORIGINAL ARTICLE

First report of upfront treatment with Gefitinib in comparison with chemotherapy in advanced non-small cell lung cancer patients from south India: Analysis of 120 patients

Robert A Louis
Department of Medical Oncology, Cancer Institute (WIA), Sardar Patel Road, Adyar, Chennai, Tamil Nadu, India
,
Rejiv Rajendranath
Department of Medical Oncology, Cancer Institute (WIA), Sardar Patel Road, Adyar, Chennai, Tamil Nadu, India
,
Prasanth Ganesan
Department of Medical Oncology, Cancer Institute (WIA), Sardar Patel Road, Adyar, Chennai, Tamil Nadu, India
,
T G Sagar
Department of Medical Oncology, Cancer Institute (WIA), Sardar Patel Road, Adyar, Chennai, Tamil Nadu, India
,
Arvind Krishnamurthy
Department of Surgical Oncology, Cancer Institute (WIA), Sardar Patel Road, Adyar, Chennai, Tamil Nadu, India
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Abstract

Background: Lung cancer is the most common cause of cancer deaths in males and sixth among females in south India. Lung cancer is being increasingly recognized among non-smokers. Materials and Methods: Stage IIIB and IV advanced non-small cell lung cancer (NSCLC) patients (n=120) treated from January 2009 to December 2010 were retrospectively analyzed. Baseline clinical parameters, treatment protocol, response to therapy and survival were noted. Decision to use upfront Gefitinib was based on parameters like female sex, non-smoking status, adenocarcinoma histology and poor PS. Progression-free survival (PFS) and overall survival (OS) were analyzed by the Kaplan Meier method and prognosis by log rank test and Cox regression. Results: Baseline parameters: median age: 60 years (22-78 years); male sex: 83 (69.2%); Stage IV: 95(79.2%); adenocarcinoma: 109 (90.8%); smokers: 66 (55%); PS 2/3: 65(54.2%); first-line therapy: Gefitinib: 47 (39.2%), chemotherapy: 73 (60.8%). Among those progressing after chemotherapy, 17 (23%) received second-line Gefitinib. After a median follow-up of 7.5 months (1-26 months), median PFS and OS were 5 months (0-23 months) and 7.5 months (1-26 mo), respectively. On univariate analysis, PFS was significantly improved for non-smokers (7 months vs 4 months, P=0.010), females (7 months vs 5 months, P=0.024) and upfront treatment with Gefitinib (10 months vs 4 months, P=0.014). The only significant factor that affected OS was female sex (18 months vs 9 months, P=0.042). No factors were significant on multivariate analysis. Among PS 2/3 patients, PFS was significantly higher with Gefitinib (n=36) than with single-agent chemotherapy (n=29) [median PFS of 10 months vs 4 months (P=0.017)]. Conclusion: In the largest series on the use of first-line Gefitinib from India, we found it to be a useful agent in the treatment of NSCLC, especially in females patients with poor PS and non-smokers, even without Epidermal Growth Factor Receptor (EGFR) mutation testing. Second-line Gefitinib may have negated the OS differences. However, EGFR mutation studies may help in further individualization of therapy.

Keywords

Gefitinib - non-small cell lung cancer - non-smokers - south India


Publication History

Article published online:
02 August 2021

© 2012. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Swaminathan R, Shanta V, Balasubramanian S. Cancer incidence and mortality in Chennai, India: 2006-2008. National Cancer Registry Program, Cancer Institute (WIA), Chennai, 2010.
  • 2 Alberg AJ, Ford JG, Samet JM. Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2 nd ed). American College of Chest Physicians. Chest 2007;132(3 Suppl):29S-55S.
  • 3 Subramanian J, Govindan R. Lung cancer in never smokers: A review. J Clin Oncol 2007;10;25:561-70.
  • 4 Taylor R, Najafi F, Dobson A. Meta-analysis of studies of passive smoking and lung cancer: effects of study type and continent. Int J Epidemiol 2007;36:1048-59.
  • 5 Heigener DF. Non-small cell lung cancer in never-smokers: A new disease entity? Onkologie 2011;34:202-7.
  • 6 Behera D, Balamugesh T. Lung cancer in India. Indian J Chest Dis Allied Sci 2004;46:269-81.
  • 7 Shajeem O, Behera D, Aggarwal AN. Chemotherapy versus best supportive care in the management of lung cancer. J Assoc Physicians India 2003;51:261-4.
  • 8 Rajappa S, Gundeti S, Talluri MR, Digumarti R. Chemotherapy for advanced lung cancer: A 5-year experience. Indian J Cancer 2008;45:20-6.
  • 9 Azzoli CG, Baker S Jr, Temin S, Pao W, Aliff T, Brahmer J, et al. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. American Society of Clinical Oncology. J Clin Oncol 2009;27:6251-66.
  • 10 NCCN Guidelines on Non-Small Cell Lung Cancer, version 3.2011. Available from: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp,http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. [Last Accessed on 2011 May].
  • 11 Parikh P, Chang AY, Nag S, Digumarti R, Bhattacharyya GS, Doval DC, et al. Clinical experience with gefitinib in Indian patients. J Thorac Oncol 2008;3:380-5.
  • 12 Chang A, Parikh P, Thongprasert S, Tan EH, Perng RP, Ganzon D, et al. Gefitinib (IRESSA) in patients of Asian origin with refractory advanced non-small cell lung cancer: subset analysis from the ISEL study. J Thorac Oncol 2006;1:847-55.
  • 13 Thatcher N, Chang A, Parikh P, Rodrigues Pereira J, Ciuleanu T, von Pawel J, et al. Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer). Lancet 2005;366:1527-37.
  • 14 Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009;361:947-57.
  • 15 Maemondo M, Inoue A, Kobayashi K, Sugawara S, Oizumi S, Isobe H, et al. North-East Japan Study Group. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med 2010;362:2380-8.
  • 16 Mitsudomi T, Morita S, Yatabe Y, Negoro S, Okamoto I, Tsurutani J, et al. West Japan Oncology Group. Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): An open label, randomised phase 3 trial. Lancet Oncol 2010;11:121-8.
  • 17 Zhou C, Wu YL, Chen G, Feng JF, Liu X, Wang C, et al. On behalf of the OPTIMAL investigators: Updated efficacy and quality-of-life (QoL) analyses in OPTIMAL, a phase III, randomized, open-label study of first-line erlotinib versus gemcitabine/carboplatin in patients with EGFR-activating mutation-positive (EGFR Act Mut_) advanced non-small cell lung cancer (NSCLC).Abstract 7520 ASCO 2011. Available from: http://chicago2011.asco.org/Abstracts.aspx. [Last Accessed on 2011 June 1].
  • 18 Rosell R, Gervais R, Vergnenegre A, Massuti B, Felip E, Cardenal F, et al. Spanish Lung Cancer Group: Erlotinib versus chemotherapy (CT) in advanced non-small cell lung cancer (NSCLC) patients (p) with epidermal growth factor receptor (EGFR) mutations: Interim results of the European Erlotinib Versus Chemotherapy (EURTAC) phase III randomized trial. Abstract 7503 ASCO 2011. Available from: http://chicago2011.asco.org/Abstracts.aspx. [Last Accessed on 2011 June 1].
  • 19 Yang CH, Fukuoka M, Mok TS, Wu YL, Thongprasert S, Saijo N, et al. Final overall survival results from a phase III randomized, open-label, first-line study of gefitinib V carboplatin/paclitaxel in clinically selected patients with advanced non-small cell lung cancer in Asia. 35th ESMO Congress. Abstract LBA2. Presented October 11, 2010. Available from: http://www.esmo.org/events/milan-2010-congress.html. [Last Accessed on 2011 June 1].
  • 20 Inoue, Kobayashi K, Maemondo M, Sugawara S, Oizumi S, Isobe H, et al. North-East Japan Study Group.Final overall survival results of NEJ002, a phase III trial comparing gefitinib to carboplatin (CBDCA) plus paclitaxel (TXL) as the first-line treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutations. Abstract 7519 ASCO 2011, Available from: http://chicago2011.asco.org/Abstracts.aspx. [Last Accessed on 2011 June 1].
  • 21 Sahoo R, Harini VV, Babu VC, Patil Okaly GV, Rao S, Nargund A, et al. Screening for EGFR mutations in lung cancer, a report from India. Lung Cancer 2011;73:316-9.