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Epidermal growth factor receptor targeted therapy with gefitinib in locally advanced and metastatic primary lung
Chong-Kin Liam1, Yong-Kek Pang, Chai-Hooi Leow
1Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. liamck@ummc.edu.my
Objective:
To describe the efficacy of monotherapy with the epidermal growth factor receptor-tyrosine kinase inhibitor, gefitinib in patients with locally advanced and metastatic primary lung adenocarcinoma.
Methods:
A retrospective analysis was undertaken of patients who had locally advanced or metastatic lung adenocarcinoma treated with gefitinib 250 mg orally once daily until disease progression. All patients had either been previously treated with systemic cytotoxic chemotherapy and/or radiotherapy or had declined chemotherapy or were medically not fit for cytotoxic chemotherapy.
Results:
A total of 23 patients (13 men) (15 never smokers) with a median age of 51 years (range 35-79 years) received gefitinib monotherapy. Disease control occurred in 14 patients (61%); there was a reduction in the size of the primary and/or metastatic tumours (partial response (PR)) in 11 patients (48%), and 3 patients (13%) had stable disease. The response rate was significantly higher in those who had never smoked (10 of 15 (67%)) compared with that of smokers (1 of 8 (13%)) (odds ratio (95% confidence interval), 14.0 (1.33-147.43) P=0.027). In total, 11 of 18 patients (61%) with a WHO performance status 1 or 2 showed a PR, whereas none with a performance status 3 or 4 responded (P=0.037). Response was not affected by the patient's age, gender, disease stage, prior chemotherapy treatment, interval between diagnosis and commencement of gefitinib or the development of skin toxicity. The median time to symptom improvement was 1.5 (range 0.5-6) weeks. The median progression-free survival time was: 60 (range 15-138) weeks in patients with PR and 34 (range 7-38) weeks in patients with stable disease (P=0.368).
Conclusion:
When given alone, gefitinib showed significant antitumour activity in patients with locally advanced and metastatic primary lung adenocarcinoma. An objective response was observed more frequently in never smokers and exclusively in patients with good performance status.
Insights
Gefitinib monotherapy demonstrated significant antitumor activity in patients with advanced lung adenocarcinoma. Responses were more frequent in never-smokers and those with good performance status.
Area of Science:
- Oncology
- Pharmacology
- Molecular Targeted Therapy
Background:
- Lung adenocarcinoma is a significant cause of cancer mortality.
- Epidermal Growth Factor Receptor (EGFR) mutations are common in lung adenocarcinoma.
- Tyrosine Kinase Inhibitors (TKIs) targeting EGFR have emerged as a treatment modality.
Purpose of the Study:
- To evaluate the efficacy of gefitinib monotherapy.
- To assess gefitinib's activity in locally advanced and metastatic lung adenocarcinoma.
- To identify patient subgroups that benefit most from gefitinib treatment.
Main Methods:
- Retrospective analysis of 23 patients with lung adenocarcinoma.
- Gefitinib 250 mg orally once daily administered until disease progression.
- Patients had either prior chemotherapy/radiotherapy or were unfit/declined chemotherapy.
Main Results:
- Disease control in 61% of patients; partial response (PR) in 48%.
- Significantly higher response rate in never-smokers (67%) vs. smokers (13%).
- Objective response exclusively in patients with good performance status (WHO PS 1-2).
Conclusions:
- Gefitinib monotherapy exhibits significant antitumour activity in lung adenocarcinoma.
- Never-smokers and patients with good performance status show superior response rates.
- Gefitinib is an effective treatment option for selected lung adenocarcinoma patients.
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