Maintenance therapy of gefitinib for non-small-cell lung cancer after first-line chemotherapy regardless of epidermal growth factor receptor mutation: a review in Chinese patients

Purpose: Gefitinib is a well known therapy for non-small-cell lung cancer (NSCLC). The purpose of this study was to review clinical reports of gefitinib as maintenance therapy after first-line chemotherapy regardless of epidermal growth factor receptor (EGFR) mutation, and assess its efficacy and safety in Chinese patients. Materials and methods: Systematic computerized searches of the following databases were conducted from the start of each database up to July 2012; these include Medline, EMBASE, CNKI and www.clinicaltrials.gov. Terms searched include 'non-small-cell lung cancer', 'NSCLC', 'lung cancer', 'lung tumor', 'gefitinib', 'Iressa', 'EGFR' and 'epidermal growth factor receptor tyrosine kinase inhibitors'. A total of 22 studies were reviewed. Results: In general, the overall response rate (ORR), disease control rate (DCR) and one year survival (OYS) of gefitinib maintenance therapy were 30.89%, 67.5% and 50.6% respectively, in addition, the median overall survival (OS) and median progression free survival (PFS) were 13.09 and 7.88 months respectively. Moreover, ORR, DCR, median survival time (MST) and PFS of female, nonsmoking, lung adenocarcinoma (LAC) patients and patients with rash had higher performance than male, smoking, non-LAC patients and patients without rash (p<0.05). The adverse events (AEs) were mainly skin rashes and diarrhea, most of which were grades 1 or 2 and were well tolerated. Conclusion: Gefitinib produced encouraging efficacy, safety and survival when delivered as maintenance therapy for NSCLC in Chinese patients after first-line chemotherapy regardless of EGFR mutation, especially for the patients who were female, non-smokers, LAC and with rash. Key limitations of this review include limited subgroup data, small sample sizes, and the lack of EGFR/KRAS data.