Second-line erlotinib after failure of pemetrexed-containing chemotherapy in advanced non-small cell lung cancer (NSCLC): Real-world effectiveness, safety and tolerability

Introduction: Little data is available on patients with advanced non-squamous NSCLC treated with erlotinib specifically after failure of first-line pemetrexed-containing chemotherapy. We assessed the effectiveness, safety and tolerability of erlotinib in a real-world setting. Methods: Prospective single-arm, open-label, multicenter, non-interventional study of erlotinib (150mg daily) in inoperable stage III/IV NSCLC after progression on first-line pemetrexed-containing chemotherapy without EGFR-mutation selection. Patients were followed according to routine practice and response assessment was performed using RECIST 1.1. The primary end point was progression-free survival (PFS). Secondary end points included best confirmed overall response rate (ORR), disease control rate (DCR), and overall survival (OS). Adverse events were recorded. An independent dataset was used to validate the results. Results: In all, 59 patients were screened, 57 enrolled, and 54 (36 men; median age 65 years) included in the per-protocol analysis. Median PFS was 1.8 (95% CI 1.4–2.6) months, with 11% (95% CI 5–21%) alive and progression-free at 6 months. The ORR was 0.0% (97.5% CI 0.0–6.8%) and the DCR 34.6% (95% CI 21.9–49.0%). Median overall survival was 5.8 (95% CI 3.3–8.6) months with 28% (95% CI 17–42%) alive at one year. Rash occurred in 60.7% (95% CI 46.7–73.5%), with severe rash in 12.5% (95% CI 5.1–24.1%). Any grade diarrhea was observed in 42.8% (95% CI 29.7–56.8%), with grade 3 occurring in 7.1% (95% CI 1.9–17.2%). Erlotinib was stopped in 21.0% (95% CI 11.3–33.9%) of patients due to adverse events, which were treatment related in 7%. Conclusion: Second-line erlotinib after pemetrexed treatment results in similar real-world outcomes as reported after non-pemetrexed containing first-line therapy. However, the overall duration of response in unselected patients remains limited and other effective treatments have in the meantime been introduced. No new safety signals were detected.