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Gefitinib Combined With Stereotactic Radiosurgery in Previously Treated Patients With Advanced NonSmall Cell Lung Cancer

Wang, Zhen MSc*; Zhu, Xi-Xu MD*; Wu, Xin-Hu MSc*; Li, Bing PhD*; Shen, Tian-Ze MSc*; Kong, Qing-Tao MSc; Li, Jing MSc*; Liu, Zhi-Bing MSc*; Jiang, Wan-Rong MSc*; Wang, Yang BSc*; Hou, Bo BSc*

American Journal of Clinical Oncology: April 2014 - Volume 37 - Issue 2 - p 148–153
doi: 10.1097/COC.0b013e31826e071b
Original Articles: Thoracic

Background: Disease progression remains the major challenge in the management of advanced (stage IIIb or IV) non–small cell lung cancer (NSCLC) after the failure of first-line or second-line chemotherapy, or even of targeted therapies such as gefitinib. The current study evaluated the tolerability and efficacy of stereotactic body radiation therapy (SBRT) in combined with gefitinib as a second-line or third-line treatment in patients with advanced NSCLC.

Methods: Fourteen advanced NSCLC patients showing disease progression after platinum-based chemotherapy regimens were recruited. Eligible patients started taking gefitinib (250 mg/d) 7 days before SBRT and continued for 1 year until disease progression, unacceptable toxicity or withdrawal of consent. SBRT was delivered in median 3 fractions within 3 to 5 days. Treatment-associated toxicity was assessed according to the Common Terminology Criteria for Adverse Events (v.3.0). Local control was assessed according to the Response Evaluation Criteria in Solid Tumors criteria and symptom assessments were measured by the Functional Assessment of Cancer Therapy-Lung instrument (V4.0).

Results: With an overall median follow-up of 15.5 months (range, 4 to 27 mo), most patients were well tolerated with common side effects from grade 1 to 2. No grade 4 or higher toxicity was encountered. The clinical disease-related symptom improvement rate was reached 57.1% with the median duration of symptom improvement of 8.0 months. The 1-year local control and overall survival (OS) rates were 83.9% and 69.6%, respectively. The median progression-free survival and OS were 7.0 and 19.0 months, respectively.

Conclusions: The SBRT combined with gefitinib is a promising treatment strategy for advanced (stage IIIb or IV) NSCLC after the failure of previously chemotherapy. This method improves local control and disease-related symptoms with tolerated toxicity, and even increases the progression-free survival and OS.

Departments of *Radiation Oncology

Dermatology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China

Supported by grant from the Nanjing Military Command of the Republic of China, Grant Number 10-MA-098.

The authors declare no conflicts of interest.

Reprints: Xi-Xu Zhu, MD, Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China. E-mail: zhuxixunju@yahoo.com.cn.

© 2014 by Lippincott Williams & Wilkins, Inc