Gefitinib First or Gefitinib Second: Is Timing Everything in the Treatment of EGFR Mutant Non–Small Cell Lung Cancer?

摘要: Somatic mutations in the epidermal growth factor receptor (EGFR) have emerged as important biomarkers in predicting the likelihood of tumor response to the EGFR tyrosine kinase inhibitors gefitinib and erlotinib in patients with advanced non–small cell lung cancer (NSCLC). EGFR mutations were originally described in 2004 in several retrospective studies and subsequently led to a number of prospective phase II clinical trials where NSCLC patients withEGFR mutations were treated with either gefitinib or erlotinib (1–6). In these prospective studies, tumor responses have been observed in 60–80% of patients and the median times to progression range from 8 to 12 months (4–6). These findings are substantially different from those typically observed with systemic chemotherapy in patients with advanced NSCLC (7). This has prompted the initiation of phase III clinical trials comparing gefitinib or erlotinib with …