Retrospective Practice Review of Treatment of Metastatic Non-Small-Cell Lung Cancer with Second-Line Erlotinib

Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and chemotherapy have both demonstrated efficacy in recurrent metastatic non-small-cell lung cancer (NSCLC) following failure of first-line platinum-based chemotherapy. Although the 3 available therapeutic agents—docetaxel, erlotinib, and pemetrexed—have significantly changed the treatment landscape for recurrent NSCLC, the optimal selection of second- and third-line therapy has not been established. This practice review examines the outcomes in clinical practice of using second-line erlotinib followed by third-line chemotherapy in the treatment of recurrent metastatic NSCLC. Methods: We conducted a retrospective review of NSCLC patient charts at three Canadian institutions. Patients with recurrent NSCLC who had received second-line erlotinib therapy followed by third-line chemotherapy were selected by census. A chart review assessed key outcomes that included time to progression (TTP), response, and change in performance status. Outcomes for specific patient subgroups were also examined. Results: We identified 35 patients for this retrospective practice review. First-line platinum-doublet therapy demonstrated a mean TTP of 6.6 months and a 46% overall response rate (15 partial responses and 1 complete response). Second-line treatment with erlotinib produced the highest mean TTP of all lines of therapy (9.2 months) and an overall response rate of 40% (all being partial responses). In the third-line setting, in which most patients received docetaxel, the mean TTP was 4.3 months and the overall response rate was 18% (all being partial responses). Subgroup analysis showed that all patient subgroups demonstrated benefit from second-line erlotinib treatment; improved benefit was observed in patients who developed rash, in female patients, in never smokers, in Asian patients, in patients with positive egfr status, and in patients with adenocarcinoma histology. Conclusions: For patients with advanced NSCLC who progressed following first-line platinum-based chemotherapy, the data demonstrate that second-line EGFR-TKI treatment is efficacious and well-tolerated and that it does not appear to diminish the benefit of third-line chemotherapy.