TY - JOUR
T1 - A phase II trial of erlotinib monotherapy in advanced pancreatic cancer as a first- or second-line agent
AU - Fountzilas, Christos
AU - Chhatrala, Ravi
AU - Khushalani, Nikhil
AU - Tan, Wei
AU - LeVea, Charles
AU - Hutson, Alan
AU - Tucker, Chris
AU - Ma, Wen Wee
AU - Warren, Graham
AU - Boland, Patrick
AU - Iyer, Renuka
N1 - Publisher Copyright:
© 2017, Springer-Verlag GmbH Germany.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Introduction: Pancreatic adenocarcinoma carries a grim prognosis. In 2007, gemcitabine with erlotinib emerged as an appropriate treatment option for patients with advanced inoperable or metastatic disease (APC). In this phase II trial we sought to evaluate the efficacy of erlotinib monotherapy in patients with APC who had disease refractory to or ineligibility for gemcitabine-based therapy. Methods: Eligible patients who had received 0 or 1 non-EGFR inhibitor containing gemcitabine-based chemotherapy for APC were recruited prospectively and treated with erlotinib 150 mg orally daily until unacceptable toxicity or disease progression. Primary endpoint was progression-free survival (PFS). Correlations of clinical response with smoking, rash, steady-state concentration of erlotinib and its metabolite (OSI-420) as well as the nicotine metabolite cotinine were performed. Results: The trial was terminated early for futility. Eighteen of the 34 planned subjects were recruited. Median PFS and OS were 42 and 95 days, respectively. Best response was stable disease (21%). There was a trend for improved PFS and OS in never smokers compared to current and past smokers (128.5, 39, 42 days and 173, 100, 88 days, respectively). Past/current smokers had lower steady-state concentrations of erlotinib and OSI-420 compared to never smokers. There was evidence of recent smoking exposure in 30% of patients self-identified as past smokers. Rash was infrequent, with no cases of grade III/IV rash and it was not related to treatment outcomes. Conclusions: Overall, erlotinib monotherapy failed to improve outcomes compared to historical controls in patients with APC after 0–1 prior systemic therapies. There was a trend for improved PFS and OS in never smokers.
AB - Introduction: Pancreatic adenocarcinoma carries a grim prognosis. In 2007, gemcitabine with erlotinib emerged as an appropriate treatment option for patients with advanced inoperable or metastatic disease (APC). In this phase II trial we sought to evaluate the efficacy of erlotinib monotherapy in patients with APC who had disease refractory to or ineligibility for gemcitabine-based therapy. Methods: Eligible patients who had received 0 or 1 non-EGFR inhibitor containing gemcitabine-based chemotherapy for APC were recruited prospectively and treated with erlotinib 150 mg orally daily until unacceptable toxicity or disease progression. Primary endpoint was progression-free survival (PFS). Correlations of clinical response with smoking, rash, steady-state concentration of erlotinib and its metabolite (OSI-420) as well as the nicotine metabolite cotinine were performed. Results: The trial was terminated early for futility. Eighteen of the 34 planned subjects were recruited. Median PFS and OS were 42 and 95 days, respectively. Best response was stable disease (21%). There was a trend for improved PFS and OS in never smokers compared to current and past smokers (128.5, 39, 42 days and 173, 100, 88 days, respectively). Past/current smokers had lower steady-state concentrations of erlotinib and OSI-420 compared to never smokers. There was evidence of recent smoking exposure in 30% of patients self-identified as past smokers. Rash was infrequent, with no cases of grade III/IV rash and it was not related to treatment outcomes. Conclusions: Overall, erlotinib monotherapy failed to improve outcomes compared to historical controls in patients with APC after 0–1 prior systemic therapies. There was a trend for improved PFS and OS in never smokers.
KW - Cotinine
KW - Erlotinib
KW - Pancreatic cancer
KW - Smoking
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U2 - 10.1007/s00280-017-3375-9
DO - 10.1007/s00280-017-3375-9
M3 - Article
C2 - 28702772
AN - SCOPUS:85023177201
SN - 0344-5704
VL - 80
SP - 497
EP - 505
JO - Cancer chemotherapy and pharmacology
JF - Cancer chemotherapy and pharmacology
IS - 3
ER -