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Imaging, Diagnosis, Prognosis |
1 Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanam-do, South Korea; Departments of 2 Pulmonology and Critical Care Medicine, 3 Thoracic and Cardiovascular Surgery, 4 Diagnostic Radiology, 5 Radiation Oncology, and 6 Pathology, Chonnam National University Medical School, Gwangju, South Korea; and 7 Department of Internal Medicine, Seonam University Medical School, Jeonbuk, South Korea
Requests for reprints: Young-Chul Kim, Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun, Jeollanam-do, 519-809 South Korea. Phone: 82-61-379-7614; Fax: 82-61-379-7010; E-mail: kyc0923{at}jnu.ac.kr.
Gefitinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, has a response rate of 10% to 20% in refractory non–small cell lung carcinoma. Although female gender, adenocarcinoma, and never having smoked are possible markers of a favorable response, mutations of the EGFR gene have also been reported to be highly significant predictors of response. Seventy patients with relapsed non–small cell lung carcinoma were enrolled in the Expanded Access Program. After the drug became available commercially, 28 more patients were treated with gefitinib. Response evaluations were feasible in 80 patients. Twenty-seven tumor specimens (8 responders and 19 nonresponders) were available for the sequence analysis of the EGFR gene. The response rate was 25% (20/80) and the disease control rate (remission + stable disease) was 47.5% (38/80). The response rate was significantly higher for adenocarcinoma (41.0%) versus non-adenocarcinoma (9.8%, P = 0.001), in those who never smoked (58.8%) versus smokers (15.9%, P < 0.001), and in females (42.1%) versus males (19.7%, P = 0.049). A deletion or mutation of the EGFR gene was found in six of eight responders. Remission was noted in all patients with a mutation, whereas the response rate was 9.5% (2/21) in patients without a mutation (P < 0.001). The predictors of response showed significant correlations with survival and time to progression. In a multivariate logistic analysis, the independent predictors of response were smoking history and adenocarcinoma. Given that 9.5% of smokers and 6.7% of those with non-adenocarcinoma showed a mutation of the EGFR gene, the genetic profile may replace those variables as an independent predictor of a response.
Key Words: Receptor, Epidermal Growth Factor • Mutation • Carcinoma, Non Small Cell Lung • Gefitinib • Prediction of response
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