[Research Paper]

Clinical Response of Gefitinib on Malignant Pleural Effusions in Patients with Non-Small Cell Lung Cancer

Chi-Hsien Chen, Chien-Hung Gow, Chong-Jen Yu, Jin-Yuan Shih, Ya-Chieh Hsu, Wen-Yu Lee, Pan-Chyr Yang, and Sow-Hsong Kuo

Department of Occupational and Environmental Medicine, National Taiwan University Hospital, Taipei, Taiwan [C.-H. Chen]; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan [C.-H. Chen; C.-H. Gow; C.-J. Yu; J.-Y. Shih; Y.-C. Hsu; W.-Y. Lee; P.-C. Yang]; Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Lotung Poh-Ai Hospital, Yi-Lan, Taiwan [C.-H. Gow]; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan [S.-H. Kuo]

Abstract:

AIM: Gefitinib has been used in the treatment of non-small cell lung cancer (NSCLC), and is known to provide favorable outcomes in some patients, especially the Asian ethnicity.  However, its ability to stop malignant pleural effusion progression in lung cancer patients remains unclear.

METHODS: The clinical response and outcome of gefitinib-treated NSCLC patients with malignant pleural effusions were reviewed retrospectively.  Their associations with epidermal growth factor receptor (EGFR) mutation and skin toxicity were also studied.

RESULTS: Fifty-six patients were included in our study.  The effusion response rate and effusion control rate were 52% and 77%, respectively.  Fifteen of the twenty patients examined were proved to have EGFR mutation.  There were favorable associations of EGFR mutation with better effusion response and longer effusion-progression-free survival (P = 0.032 and 0.02, respectively).  Gefitinib-induced skin toxicity was also associated with better effusion response (P = 0.003).  Seventeen patients had received pleurodesis before starting gefitinib.  In those who did not receive pleurodesis, the maximal effusion response was correlated with their extra-pleural response (P < 0.001).  The median effusion-progression-free survival between the non-pleurodesis and pleurodesis group had shown no significant difference (5.0 and 4.8 months, respectively, P = 0.81).

CONCLUSION: Effusion control and response rates are high in gefitinib-treated NSCLC patients.  Early pleurodesis can be withheld in NSCLC patients taking gefitinib.

(Keywords: gefitinib; EGFR mutation; pleural effusion; lung cancer)

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Received 2/28/08; Revised 3/12/08; Accepted 3/14/08.

1. Correspondence: Dr. Jin-Yuan Shih, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. Phone: 886-2-23562905. Fax: 886-2-23582867. E-mail: jyshih@ntu.edu.tw

2. Abbreviations: EGFR, epidermal growth factor receptor; TKI, tyrosine kinase inhibitor; NSCLC, non-small cell lung cancer; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; NPD, non-progressive disease.

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