Risk factors for interstitial lung disease and predictive factors for tumor response in patients with advanced non-small cell lung cancer treated with gefitinib

Analysis of Intratumor Heterogeneity of EGFR Mutations in Mixed Type Lung Adenocarcinoma

“…17 Thus, the present result is comparable with previous reports. Conversely, EGFR mutations have been reported to be significantly associated with never-smoking status, 18,19 although several studies have shown that some Japanese patients with a smoking history harbor EGFR mutations. In two randomized, prospective, phase III trials in patients with advanced NSCLC harboring EGFR mutations, 141 of 400 (35.3%) patients had a smoking history.…”

Gefitinib-induced Acute Fatal Respiratory Failure in a Woman who Never Smoked and had Adenocarinoma of the Lung with EGFR Mutation

“…In addition, a recent retrospective analysis by Fujiwara et al 4 showed that all eleven patients with EGFR mutation didn't demonstrate any pulmonary toxicity with receiving gefitinib therapy. Although the results from clinical studies 1,3 have classified males, never-smokers and non-adenocarcinoma patients as the risk group for developing adverse respiratory effects, how the somatic or genomic mutation of the EGFR gene affects the mechanism of gefitinib induced lung injury is still unknown, and this will require future study.…”

“…The prevalence of interstitial lung disease as a adverse consequence of gefitinib therapy is 2% in the Japanese and 0.3% in Americans 1,2 ; one third of these patients are fatalities. The clinical characteristics that predict adverse pulmonary effects are known to be being a male patient and the presence of a smoking history 1,3 . Those patients with a low probability of EGFR mutation have a low possibility of achieving a beneficial effect from gefitinib.…”

Systemic Tumor Embolism Mimicking Gefitinib ('IRESSA')-induced Interstitial Lung Disease in a Patient with Lung Cancer

“…ILD has been reported frequently in patients with lung cancer receiving gefitinib (5)(6)(7)(8). Although the median time to onset of gefitinib-induced ILD was reported to be 24 days in Japan and 42 days in the U.S., there was a rare case developing ILD at seven months after gefitinib administration (7).…”

“…In phase I and II clinical trials, gefitinib exhibited antitumor activity for advanced non-small cell lung cancer (NSCLC) (2)(3)(4). As well as 'gefitinib-induced interstitial lung disease' (ILD), severe pulmonary toxicity has been observed in patients receiving gefitinib (5)(6)(7)(8). In Japan, the incidence of gefitinib-induced ILD has been reported to be about 4% (5,6), with approximately one-third of the cases being fatal (7), although in the rest of the world the incidence is only around 0.3%.…”