Prognostic Model to Predict Outcomes in Non-Small Cell Lung Cancer Patients with Erlotinib as Salvage Treatment

Abstract

Purpose: To devise a prognostic model based on clinical parameters for non-small cell lung cancer (NSCLC) patients treated with erlotinib as a salvage therapy. Patients and Methods: Between July 2006 and September 2008, two hundred fifty-seven metastatic/relapsed NSCLC patients who had been treated with erlotinib as a salvage therapy were analyzed retrospectively. Results: For the 257 patients, the median overall survival (OS) and progression-free survival (PFS) with erlotinib treatment were 12.4 and 2.8 months. Multivariate analysis showed that an ECOG performance status of 2 or more, an elevated serum LDH level, and the absence of skin rash were independent adverse prognostic factors for OS and that the presence of intra-abdominal metastasis, 2 or more prior chemotherapy regimens, and the absence of skin rash were prognostic factors for PFS. Patients were categorized into the following 4 prognosis groups on the basis of each adverse prognostic factor: good, intermediate, poor, and very poor prognosis. The median OS times for the good, intermediate, poor, and very poor prognosis groups were 22.0, 9.3, 5.4, and 2.7 months (p < 0.001) and the median PFS times were 6.5, 3.0, 1.2, and 0.9 months (p < 0.001). Conclusion: This prognostic model based on clinical parameters would be useful to identify patients who might be most likely to benefit from erlotinib therapy in clinical practice.

Clinical Outcomes and Prognostic Factors Associated with the Response to Erlotinib in Non-Small-Cell Lung Cancer Patients with Unknown EGFR Mutational Status

“…However, in our study, smoking history was not significantly associated with OS. This finding is similar to the results of two recent Asian studies (Uhm et al, 2009;Kim et al, 2010). These studies reported that, on a multivariate level, smoking status did not retain significance for OS or time to progression in patients with advanced NSCLC who were treated with erlotinib as a salvage therapy.…”

“…Of these prognostic factors, PS, weight loss, and the number of prior regimens played a significant prognostic role for OS in our study. In two recent retrospective studies, an ECOG PS of 2 or more, elevated serum LDH, and the absence of skin rash (Kim et al, 2010), as well as low BMI, stage IV disease, anaemia at diagnosis, and male gender (Hsu et al, 2012), were shown to be adverse prognostic factors for OS. Unlike these previous studies, the presence of an intra-abdominal metastasis was a negative prognostic factor for survival in patients with metastatic NSCLC treated with erlotinib in our study.…”

Comparison of Clinical Outcomes Following Gefitinib and Erlotinib Treatment in Non–Small-Cell Lung Cancer Patients Harboring an Epidermal Growth Factor Receptor Mutation in Either Exon 19 or 21

“…And a previously reported study also demonstrated that the presence of intra-abdominal metastasis was correlated with poor prognosis in NSCLC patients treated with erlotinib as salvage therapy. 14 In univariate analysis, patients treated with EGFR TKI as first-line treatment seemed to have a longer PFS than those with prior cytotoxic chemotherapy before EGFR TKI treatment. However, longer PFS trend associated with first-line EGFR TKI treatment was diminished in then multivariate analysis (hazard ratio, 1.32; 95% CI 0.92-1.88; p = 0.135).…”

Effectiveness and cost-effectiveness of erlotinib versus gefitinib in first-line treatment of epidermal growth factor receptor–activating mutation-positive non–small-cell lung cancer patients in Hong Kong

“…Such differences are important, as at least age, performance status, and tumour stage were predictors of progression-free survival (PFS) in NSCLC. 7,[17][18][19] …”