The Efficacy And Survival Analysis In Patients With Advanced Non-Small Cell Lung Cancer Treated With Gefitinib

Objective:This study compared the overall survival (OS) between advanced lung adenocarcinoma patients of before and after gefitinib approval in China and analyzed the clinical factors.Methods:The clinical data of558advanced lung adenocarcinoma patients who ever received palliative chemotherapy referred to the Cancer Hospital&Institute, Chinese Academy of Medical Sciences from Jan,2002through Dec,2010were reviewed retrospectively. According to a matched-pair case-control study design,255patients of before gefitinib approval who only received palliative chemotherapy and255patients of after gefitinib approval who received gefitinib treatment were stringently matched by age, sex and smoking history. The clinical factors including age, sex,smoking history, Eastern Cooperative Oncology Group performance status (ECOG PS), tumor stage, sites of metastasis and numbers of prior cytotoxic chemotherapy regimens were analyzed for the correlation with OS. The impact of tumor response was assessed using a χ2test. Survival curves were constructed using the Kaplan-Meier method and differences between survival curves were evaluated by the log-rank test. Cox proportional hazard analysis was performed to explore the effect of each factors on survival. Differences were considered significant if p<0.05. All the calculations were performed in SPSS16.0.Results:The median survival time (MST) of510advanced lung adenocarcinoma patients from the date of first administration of palliative chemotherapy was22.8months(95%Confidence Interval [95%CI],20.7months-24.9months).MST was significantly longer among the patients treated with gefitinib after gefitinib approval compared with the MST of patients treated before gefitinib approval (33.5vs.14.1months, p<0.001). Multivariate analysis showed that the independent prognostic factors to significantly improve the OS of510patients included gefitinib treatment(Hazard Ratio[HR]0.175,95%CI0.140-0.219,P<0.001),age<60years(HR0.787,95%CI0.649-0.955,P=0.015),non-smoker(HR2.103,95%CI1.608-2.750, p<0.001), no hepatic metastasis(HR1.501,95%CI1.085-2.077, p=0.014) and receiving≥3 prior cytotoxic chemotherapy regimens(HR0.298,95%CI0.230-0.386,p<0.001). Patients after gefitinib approval showed significantly longer OS in almost all clinical factors subgroups (p<0.001) including age, sex,smoking history, ECOG PS0-1, tumor stage, sites of metastasis including lung, Pleural, bone, brain, adrenal gland, liver and numbers of prior cytotoxic chemotherapy regimens, except ECOG PS≥2subgroup(p=0.090). In the gruop after gefitinib approval,the objective response rate(ORR) and disease control rate(DCR) were34.1%and88.6%, respectively. MST of255patients after gefitinib approval from the date of receiving gefitinib was24.0months(95%CI,21.7months-26.3months).MST from receiving gefitinib was significantly longer among the patients with brain metastasis(p=0.038),no adrenal gland metastasis(p=0.017) and EGFR mutation(p=0.048). Multivariate analysis showed that the independent prognostic factors to significantly improve the OS from receiving gefitinib of255patients after gefitinib approval included non-smoker(p=0.005), lung metastasis(p=0.032), no adrenal gland metastasis(p=0.020) and EGFR mutation(p=0.012).Conclusion:Gefitinib treatment significantly improved the survival of the patients with advanced lung adenocarcinoma in China. Objective:To explore the efficacy and survival of gefitinib for elderly patients with advanced NSCLC.Methods:The clinical data of83elderly advanced NSCLC patients referred to the Cancer Hospital&Institute, Chinese Academy of Medical Sciences from Jan,2007through Jun,2009were analyzed retrospectively.Results:The median age of83elderly patients with advanced NSCLC was70years old.The objective response rate and oisease control rate were32.5%and85.5%. There was significantly statistical differences in disease control rate between two groups who had smoking history or not (P=0.049). The median progression free survival was11.6months. Among the factors analyzed, sex, smoking history or not, pathological type and the clinical benefit rate had significant effects on the progression free survival. The median overall survival was24.0months. The independent prognostic factors to significantly improve the overall survival included adenocarcinoma (P<0.001), the clinical benefit rate (P=0.029) and receiving other anti-cancer treatment after gefitinib (P=0.006).Conclusion:Gefitinib is a effective treatment for elderly patients with advanced NSCLC.