Clinical observation on EGFR-TKIs versus chemotherapy in maintenance therapy in advanced non-small cell lung cancer

Abstract

Objective EGFR-TKIs as gefitinib or cytotoxic chemotherapy drugs as gemcitabine and pemetrexed are all effective regimens in maintenance therapy in advanced NSCLC. In order to compare the clinical efficacy of these two maintenance therapy stategies, we carried out this research. Methods In our retrospective study, there were 65 advanced NSCLC patients received gefitinib, gemcitabine or pemetrexed maintenance therapy. These patients were divided into gefitinib or chemotherapy maintenance therapy groups. The difference such as disease control rate, PFS, and OS between the two groups were analyzed. Results 34 of 65 patients received gefitinib maintenance therapy (10 of 34 patients known as EGFR mutations), and the other 31 patients received chemotherapy maintenance therapy (21 patients received gemcitabine maintenance therapy, 10 patients received pemetrexed maintenance therapy). There were no statistically significant differences between gefitinib and chemotherapy maintenance therapy groups in disease control rate (70.6% vs.64.5%, P=0.791), PFS (6.4 months vs.5.0 months, P=0.110), and OS (16.3 months vs.12.0 months, P=0.327). In stratified analysis, the PFS and OS were also not significantly different among gefitinb, gemcitabine, and pemetrexed maintenance therapy groups when EGFR mutation status was unknown (4.0 months vs.4.0 months vs.5.0 months, P=0.462) (14.4 months vs.12.0 months vs.12.2 months, P=0.540). However, in gefitinb maintenance therapy group, the PFS and OS of EGFR mutation positive patients were significantly longer than those of the EGFR mutation unknown patients (11.2 months vs.4.0 months, P=0.001) (31.9 months vs.14.4 months, P=0.02). Conclusions The efficacy was similar between gefitinib and chemotherapy maintenance therapy in advanced NSCLC. But there was more survival benefit in EGFR mutation patients than EGFR mutation unknown patients when gefitinib maintenance therapy was adopted, so, we suggested that EGFR mutation status should be routinely detected if gefitinib would be used in maintenance therapy in advanced NSCLC. Key words: Non-small cell lung cancer; EGFR-TKIs; Gefitinib; Gemcitabine; Pemetrexed; Maintenance therapy