Kinase Inhibitors or Docetaxel in Second-Line Treatment of EGFR Wild-Type Non-small-Cell Lung Cancer: A Retrospective Real-World Practice Review at a Single Tertiary Care Centre

Background Treatment for advanced non-small-cell lung cancer (NSCLC), especially in patients with wild-type EGFR, remains limited. Recently, erlotinib, a tyrosine kinase inhibitor (TKI) targeting EGFR mutation, was approved as second-line treatment in EGFR wild-type NSCLC. Despite evidence of better overall survival (OS) with chemotherapy than with TKI in second-line treatment, data on the use of TKI in the real-life clinical setting remain limited. The present practice review of TKI use for second- and third-line treatment in EGFR wild-type NSCLC also compares clinical outcomes for TKI and single-agent docetaxel as second-line treatment. Methods Our retrospective cohort study included patients with EGFR wild-type NSCLC treated at the Jewish General Hospital (Montreal, QC) between 2003 and 2013. Patients received a TKI (erlotinib or gefitinib) in the second and third line or docetaxel in the second line. For each group, we determined OS, disease control rate, progression-free survival (PFS), and event-free survival (EFS). Results The TKI group included 145 patients, with 92 receiving second-line treatment. In the control group, 53 patients received docetaxel as second-line therapy. In the TKI group, OS was 6.0 months; PFS, 2.7 months; and EFS, 3.0 months. Comparing second-line treatments, OS was 5.3 and 5.0 months respectively (p = 0.88), PFS was 2.5 and 1.8 months respectively (p = 0.041), and EFS was 3.0 and 1.7 months respectively (p = 0.009). Conclusions In our study cohort, second-line therapy for EGFR wild-type NSCLC with TKI (compared with docetaxel) was associated with statistically better PFS and EFS and noninferior OS. Those findings raise the question of whether EFS should also be considered when choosing second-line treatment in this patient population.