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Background  The toxicity of epidermal growth factor receptor ( EGFR ) tyrosine kinase inhibitors (TKIs) is less than that of cytotoxic agents. The reports of dramatic response and improvement in performance status with the use of  EGFR  TKIs may influence a physician’s decision-making for patients with non-squamous non-small cell lung cancer (NSCLC) and life-threatening respiratory distress. The aim of this study was to evaluate the outcome of rescue or maintenance therapy with  EGFR  TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation.    Methods  Eighty-three Asian patients with stage IIIb-IV non-squamous NSCLC and who required mechanical ventilation between June 2005 and January 2010 were evaluated.    Results  Of the 83 patients, 16 (19%) were successfully weaned from the ventilator. The use of  EGFR  TKI as rescue or maintenance therapy during respiratory failure did not improve the rate of successful weaning (standard care 18% vs. with  EGFR  TKI, 22%;  p =  0.81) in univariate and multivariate analyses.    Conclusions  Rescue or maintenance therapy with  EGFR  TKI for stage IIIb-IV non-squamous NSCLC patients requiring mechanical ventilation was not associated with better outcome. An end-of-life discussion should be an important aspect in the care of this group of patients, since only 19% were successfully weaned from mechanical ventilation.

bmc anesthesiology

The impact of rescue or maintenance therapy with EGFR TKIs for Stage IIIb-IV non-squamous non-small-cell lung cancer patients requiring mechanical ventilation