Abstract
BackgroundEpidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) readministration to lung cancer patients is common owing to the few options available. Impact of clinical factors on prognosis of EGFR-mutant non-small cell lung cancer (NSCLC) patients receiving EGFR-TKI readministration after first-line EGFR-TKI failure and a period of TKI holiday remains unclear. Through this retrospective study, we aimed to understand the impact of clinical factors in such patients.MethodsOf 1386 cases diagnosed between December 2010 and December 2013, 80 EGFR-mutant NSCLC patients who were readministered TKIs after failure of first-line TKIs and intercalated with at least one cycle of cytotoxic agent were included. We evaluated clinical factors that may influence prognosis of TKI readministration as well as systemic inflammatory status in terms of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR).Baseline NLR and LMR were estimated at the beginning of TKI readministration and trends of NLR and LMR were change amount from patients receiving first-Line TKIs to TKIs readministration.ResultsMedian survival time since TKI readministration was 7.0 months. In the univariable analysis, progression free survival (PFS) of first-line TKIs, baseline NLR and LMR, and trend of LMR were prognostic factors in patients receiving TKIs readministration. In the multivariate analysis, only PFS of first-line TKIs (p < 0.001), baseline NLR (p = 0.037), and trend of LMR (p = 0.004) were prognostic factors.ConclusionLonger PFS of first-line TKIs, low baseline NLR, and high trend of LMR were good prognostic factors in EGFR-mutant NSCLC patients receiving TKI readministration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2917-6) contains supplementary material, which is available to authorized users.
Highlights
Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) readministration to lung cancer patients is common owing to the few options available
non-small cell lung cancer (NSCLC) patients with higher blood neutrophil-tolymphocyte ratio (NLR) had poor prognosis when treated with a combination of bevacizumab and cytotoxic agents [13]; those with higher lymphocyte-to-monocyte ratio (LMR) had better prognosis in EGFR-mutant NSCLC patients receiving first-line EGFR-TKIs [14]
Baseline NLR and LMR were estimated at the beginning of TKI readministration and trends of NLR and LMR were obtained by dividing the data estimated at the beginning of TKI readministration with the data estimated at the beginning of first-line TKIs
Summary
Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) readministration to lung cancer patients is common owing to the few options available. Impact of clinical factors on prognosis of EGFR-mutant non-small cell lung cancer (NSCLC) patients receiving EGFR-TKI readministration after first-line EGFR-TKI failure and a period of TKI holiday remains unclear. Through this retrospective study, we aimed to understand the impact of clinical factors in such patients. Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are administered as standard first-line regimen for advanced EGFR-mutant non-small cell lung cancer (NSCLC) [3,4,5], the salvage treatment for cases with acquired resistance to EGFR-TKIs remains unclear. In non-selective patients, EGFR-TKI readministration has only modest efficacy with a progression free survival (PFS) of 2–4 months [10, 12]. NSCLC patients with higher blood neutrophil-tolymphocyte ratio (NLR) had poor prognosis when treated with a combination of bevacizumab and cytotoxic agents [13]; those with higher lymphocyte-to-monocyte ratio (LMR) had better prognosis in EGFR-mutant NSCLC patients receiving first-line EGFR-TKIs [14]
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