Abstract
e18005 Background: Two active epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) gefitinib and erlotinib are available for NSCLC patients. In Japan, gefitinib was commonly used as first EGFR-TKI and 30% of non-selected NSCLC patients experienced dramatic tumor regressions with gefitinib. However, the majority of these patients eventually develop disease progression after a median of about 10 months. Because of poor drug penetration, the central nervous system (CNS) is a common relapsed site after gefitinib treatment failure. Another EGFR-TKI, erlotinib was used at 150mg daily dose which is maximum tolerated dose and this setting was higher than setting of gefitinib. Therefore, erlotinib may be still effective for CNS metastases after gefitinib treatment failure. In this study, we evaluated the efficacy of erlotinib in NSCLC patients who had CNS relapse after gefitinib treatment failure. Methods: We identified 27 NSCLC patients who had disease progression of CNS metastases during or after gefitinib treatment and received erlotinib monotherapy. Characteristics of these patients were followed, 24 women and 3 men, median age 60 y.o., PS 0/1/2; 9/11/7, 26 adenocarcinoma/1 large cell carcinoma, 6 smoker/21 non-smoker. Results: Response of CNS metastases with erlotinib treatment was evaluated in 25 of 27 patients. 11 PR, 10 SD and 2 PD of CNS metastases were observed. While response rate (RR) of extra CNS disease was 24%, RR of CNS metastases were 40.1%. Disease control rate (DCR) was 77.8%, respectively. The median duration of erlotinib treatment was 16 weeks. The symptom improvements of CNS metastases were observed in 6 of 27 patients (22.2%). Conclusions: CNS relapse in NSCLC patients after gefitinib treatment may still have tumors that remain sensitive to erlotinib. After gefitinib treatment failure, erlotinib may prolong EGFR-TKI efficacy, especially for CNS relapse. No significant financial relationships to disclose.
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