Objective: The objective of this study was to compare the efficacies of gefitinib and erlotinib in treating EGFR-mutated non-small-cell lung cancer (NSCLC) patients.

Methods: 319 EGFR-mutated NSCLC patients who had been treated with gefitinib or erlotinib at a Macau government hospital between 2005 Jan and 2015 Dec were retrospectively reviewed. Primary endpoint was overall survival (OS); progression-free survival (PFS) and disease control rate (DCR) were also analyzed.

Results: 259 patients were included in OS analysis. Nearly all patients were Asian (> 99%). The median age in gefitinib group and erlotinib group were 62.5 and 60 respectively. Female patients predominated in gefitinib group (71.8% vs 46.6%, p< 0.0001) and there was significantly more smokers or ever-smokers in erlotinib group (19.2% vs 35.0%, p= 0.0046). Most patients were at a late stage of disease (stage III and IV~ 85%) and> 60% of patients received EGFR-TKI first-line. The median OS and PFS in gefitinib group and erlotinib group were 20.2 versus 26.3 months (p= 0.0912) and 11.9 versus 13.4 months (p= 0.0162) respectively, DCR was 72.1% versus 81.1%(p= 0.0799). Although erlotinib resulted in the better outcome, the difference was only significant with PFS. In the subgroup of patients receiving TKI first-line, erlotinib also showed a longer OS (19.2 vs. 34.6 months, p= 0.0165).

Conclusion: For patients with EGFR mutations, gefitinib and erlotinib resulted in similar overall survival and disease control rate, but a significantly longer progression-free survival was observed with erlotinib. In patients receiving TKI as first-line therapy, erlotinib-treated patients also had a longer overall survival.