Background: Randomized trials of advanced non-small cell lung cancer (NSCLC) have demonstrated the activity of docetaxel in second-line and erlotinib in the third-line setting after failure of platinum-based chemotherapy. The role of epidermal growth factor receptor tyrosine kinase inhibitors (EGFRTKI) as second-line treatment prior to docetaxel is currently the subject of ongoing trials. Here we explore the outcomes of these agents' uses in clinical practice.
Method: A retrospective review of the NSCLC database at Princess Margaret Hospital in Toronto, Canada was undertaken. Patients who have previously received docetaxel after failure of platinum-based chemotherapy were identified and a chart review was undertaken to further identify those who also received an EGFRTKI to assess their clinical benefits. Primary outcome assessed was response rate and secondary outcomes were time to progression (TTP) and overall survival (OS).
Results: Seventy-four patients received docetaxel for advanced NSCLC from 2001 to 2006, 52 (70%) as second line and 22 (30%) as third line. Twenty-two and 31 of these patients received second- and third-line EGFRTKI, respectively. In the second-line setting, the overall response rate was 10% in the EGFRTKI group and 9% in the docetaxel-treated patients. In the third-line setting, this was 20% and 5%, respectively (p-value 0.29). In both the second- and third-line setting, TTP and OS were not significantly different between the two groups.
Conclusion: For patients with advanced NSCLC who progressed following first-line platinum-based chemotherapy, the use of an EGFRTKI in second line appears to be equivalent to docetaxel chemotherapy, and docetaxel has activity third line, post EGFRTKI therapy.