• Kaoru Kubota, Yutaka Nishiwaki, Tomohide Tamura, Kazuhiko Nakagawa, Kaoru Matsui, Koshiro Watanabe, Toyoaki Hida, Masaaki Kawahara, Nobuyuki Katakami, Koji Takeda, Akira Yokoyama, Kazumasa Noda, Masahiro Fukuoka, and Nagahiro Saijo.
• National Cancer Center Hospital East, Kashiwa, Chiba, Japan. kkubota@east.ncc.go.jp
• J Thorac Oncol. 2008 Dec 1;3(12):1439-45.

IntroductionThe aim of this study was to evaluate the efficacy and safety of Erlotinib in Japanese patients with previously treated non-small cell lung cancer (NSCLC). Available tumor biopsy samples were analyzed to examine relationships between biomarkers and clinical outcome.MethodsThis open-label phase II trial enrolled stage III/IV NSCLC patients who had progressive disease after at least one prior platinum-based chemotherapy regimen. Erlotinib was administered at a dose of 150 mg/d orally until disease progression or intolerable toxicity. Analysis of epidermal growth factor receptor gene mutations in exon 18-21 by direct sequencing was performed in tumor tissue specimens obtained at the first diagnosis.ResultsSixty-two patients were enrolled and 60 patients were evaluable for efficacy. Objective response rate and disease control rate were 28.3% and 50.0%; median time to progression and overall survival were 77 days and 14.7 months, respectively. In logistic regression analysis, only smoking history was proved to be a statistically significant predictive factor for response (odds ratio: 0.06, p < 0.001). Only 7 patients had samples available for mutation analysis. Three patients who had deletion mutations on exon 19 (del E746-A750 or del S752-I759) exhibited objective response. Common toxicities were rash (98%), dry skin (81%), and diarrhea (74%). Discontinuation due to adverse events occurred in 11 patients (18%). Four patients (6%) experienced interstitial lung disease-like events, one of whom died.ConclusionsErlotinib is efficacious in Japanese patients with previously treated NSCLC. The toxicity profile was similar to that in Western patients, except for a somewhat higher incidence of skin disorders and interstitial lung disease. Further studies are needed to determine the relationship between epidermal growth factor receptor mutations and outcomes with Erlotinib in Japanese patients.

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