Erlotinib in wild type epidermal growth factor receptor non-small cell lung cancer: a systematic review

Targeting epidermal growth factor receptors [EGFR] is an innovative approach to managing non-small cell lung cancer [NSCLC] which harbors EGFR mutation. However, the efficacy of these agents like erlotinib in patients without the mutation is not known. This systematic review included Phase III randomized clinical trials that compared single agent erlotinib to other management options in the setting of NSCLC with reported outcome data on patients with EGFR wild type [EGFRWT] tumors. Outcome data include overall survival [OS], progression free survival [PFS] and response rate [RR]. Random effects meta-analysis was used to pool outcomes across studies. Three studies met the inclusion criteria. These studies included a total of 2044 patients with outcome data on 674 patients with EGFRWT tumors [33%]. Meta-analysis revealed a statistically significant improvement in OS with erlotinib [hazard ratio of 0.780; 95% confidence interval: 0.654-0.930, P = 0.006]. Data were not available to perform PFS or RR analysis. The quality of this evidence is considered to be moderate to high. Our study revealed a significant benefit of erlotinib in patient with EGFRWT tumors compared with other approaches. These findings add another therapeutic option to patients generally considered difficult to treat

Integration of evidence based medicine into the clinical years of a medical curriculum

Teaching Evidence Based Medicine [EBM] helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone [classroom] teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum