Erlotinib for metastatic non-small-cell lung cancer: First-, second- or third-line setting - Does it matter? A single-institution experience

Background: Erlotinib is approved as treatment for metastatic non-small-cell lung cancer (NSCLC), following failure of initial therapy. Studies to define patients that derive maximal benefit from erlotinib have not dictated current practice. Methods: We retrospectively analyzed the prescription patterns and outcomes related to erlotinib use for NSCLC in a comprehensive cancer center. Results: Of 137 consecutive patients treated with erlotinib over 2 years, 116 were evaluable. Median age was 66 years, 63% females, most common histology was adenocarcinoma (n = 58). Seventy-nine patients presented with stage IIIB-IV disease, 37 with recurrent disease. There were 109 smokers. Erlotinib was given first line in 31 (27%), second line in 52 (45%) and third line in 33 (28%) patients. Daily erlotinib dose was 100 mg in 21 (18%) and 150 mg in 91 (82%) patients. Median duration of treatment was 8 weeks (range 1-72). Median overall survival (OS) from initiation of erlotinib was 5.4 months (range 0.2-27.8). There was no significant difference in median survival by disease stage (recurrent vs. de novo IIIB-IV) (p = 0.201), whether erlotinib was used as first-, second-, third-line therapy (p = 0.971) or at different doses (100 vs. 150 mg daily dose) (p = 0.579). Conclusions: OS after erlotinib use was not different, whether used as first-, second- or third-line therapy, whether patients had recurrent metastatic NSCLC or de novo stage IV disease, or if erlotinib was used at a dose of 100 or 150 mg daily.