Abstract | INTRODUCTION: METHODS: Relevant randomized trials published as articles or abstracts were identified through a systematic search of the literature from 1975 to November 2005 by two independent reviewers. RESULTS: Twelve randomized trials met the predefined eligibility criteria for this systematic review. Four large placebo-controlled trials demonstrated that the addition of gefitinib or erlotinib to platinum-based first-line chemotherapy did not significantly improve overall survival or time-to- disease progression. A large placebo-controlled trial revealed a clinically and statistically significant survival benefit for erlotinib therapy as second- or third-line systemic therapy. The results of a single placebo-controlled trial and two phase II trials suggest that modest tumor response rates and symptom control can be achieved with gefitinib as second-line or subsequent therapy; however, a statistically significant survival benefit was not found for gefitinib compared with placebo. CONCLUSION: There is strong evidence to recommend against the use of gefitinib or erlotinib in combination with chemotherapy or as maintenance therapy after chemotherapy and radiation as a first-line treatment for advanced NSCLC. Erlotinib monotherapy is an effective treatment that can prolong survival for patients with advanced NSCLC whose disease has relapsed or recurred after prior chemotherapy. Although a significant survival benefit has not been demonstrated for gefitinib in a placebo-controlled study, the two randomized phase II trials suggest that gefitinib may provide clinically important symptomatic benefits.
|
Authors | Ron Feld, Srikala S Sridhar, Frances A Shepherd, Jean A Mackay, William K Evans, Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care |
Journal | Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
(J Thorac Oncol)
Vol. 1
Issue 4
Pg. 367-76
(May 2006)
ISSN: 1556-1380 [Electronic] United States |
PMID | 17409886
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
|
Chemical References |
- Quinazolines
- Erlotinib Hydrochloride
- ErbB Receptors
- Gefitinib
|
Topics |
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Carcinoma, Non-Small-Cell Lung
(drug therapy, mortality, psychology)
- Dose-Response Relationship, Drug
- ErbB Receptors
(antagonists & inhibitors)
- Erlotinib Hydrochloride
- Gefitinib
- Humans
- Lung Neoplasms
(drug therapy, mortality, psychology)
- Quality of Life
- Quinazolines
(adverse effects, therapeutic use)
- Randomized Controlled Trials as Topic
|