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Updated: May 11, 2026
Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
Initial Progression-Free Survival after Non-First Line TKIs Therapy Potentially Guides Immediate Treatment after Its
Fang Wang1, Gui-Fang Guo, Hui-Juan Qiu
1State Key Laboratory of Oncology in South China, Guangzhou 510060, China ; VIP Region, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Objective:
The standard therapy after failure of the initial non-first line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment in advanced non-small cell lung cancer (NSCLC) has not yet been established. The aim of the current study was to identify whether the 2(nd) TKI treatment or chemotherapy (paclitaxel-containing or non-paclitaxel regimen) is the appropriate treatment for patients with NSCLC based on the efficacy of the initial TKIs.
Methods:
Seventy-two advanced NSCLC patients who had accepted 2(nd) TKIs or chemotherapy immediately after failure of the initial TKIs in non-first line setting from May 1, 2004 to January 31, 2010 at the Sun Yat-sen University Cancer Center were enrolled. The primary endpoint [2(nd) progression-free survival (PFS)] and the second endpoint [overall survival (OS)] were compared among the 2(nd) TKI and chemotherapy groups as well as their subgroups.
Results:
(1) Twenty-one patients were treated with 2(nd) TKIs, and 51 patients were administered chemotherapy after failure of the initial non-first line TKI treatment. There was nonsignificant difference in the responses (P=0.900) [2(nd) PFS (P=0.833) and OS (P=0.369)] between the 2(nd) TKI and chemotherapy groups. (2) In the 2(nd) TKI group, 9 patients exhibited PFS≥7 months. The initial TKI treatment group exhibited a longer 2(nd) PFS than the other 12 patients with an initial PFS<7 months (7 months vs. 2 months, P=0.019). However, these groups had nonsignificantly different OS (P=0.369). (3) In the chemotherapy group, patients with PFS<5 months exhibited longer 2(nd) PFS than those with PFS ≥ 5 months in the initial TKI treatment (3 months vs. 2 months, P=0.039). (4) In the chemotherapy group, patients treated with paclitaxel-containing regimen showed longer 2(nd) PFS than those treated with non-paclitaxel regimen (5 months vs. 2.3 months, P=0.043).
Conclusions:
Patients with PFS≥7 months or <5 months under the initial TKI treatment potentially benefit from the 2(nd) TKI treatment or chemotherapy immediately after failure of the non-first line TKIs. The paclitaxel-containing regimen may improve the 2(nd) PFS. However, more patient samples are urgently needed to validate these findings.
Insights
Second-line tyrosine kinase inhibitors (TKIs) or chemotherapy show similar efficacy after initial EGFR-TKI failure in advanced non-small cell lung cancer (NSCLC). Paclitaxel-containing chemotherapy may improve progression-free survival (PFS).
Area of Science:
- Oncology
- Medical Research
- Pharmacology
Background:
- Standard therapy after initial epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) failure in advanced non-small cell lung cancer (NSCLC) remains undefined.
- Identifying optimal second-line treatment is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the efficacy of second-line TKIs versus chemotherapy in advanced NSCLC patients previously treated with non-first-line EGFR-TKIs.
- To determine if initial TKI efficacy influences the choice of second-line treatment.
Main Methods:
- Retrospective analysis of 72 advanced NSCLC patients treated with second-line TKIs or chemotherapy after initial EGFR-TKI failure.
- Comparison of second progression-free survival (PFS) and overall survival (OS) between treatment groups.
Main Results:
- No significant difference in response, second PFS, or OS between second-line TKI and chemotherapy groups.
- Patients with initial PFS ≥ 7 months showed longer second PFS with second-line TKIs (7 vs. 2 months).
- Paclitaxel-containing chemotherapy regimens demonstrated longer second PFS compared to non-paclitaxel regimens (5 vs. 2.3 months).
Conclusions:
- Second-line TKIs or chemotherapy may benefit selected NSCLC patients after initial EGFR-TKI failure, particularly those with specific initial PFS.
- Paclitaxel-based chemotherapy might enhance second-line PFS.
- Larger studies are needed to confirm these findings and guide treatment decisions.
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