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

Self-directed learning in health professions education

<p><b>INTRODUCTION</b>Self-directed learning has been recommended as a promising methodology for lifelong learning in medicine. However, the concept of self-directed learning continues to be elusive, with students and educators finding difficulty in defining it and agreeing on its worth.</p><p><b>METHODS</b>In this paper we review the literature of self-directed learning in health professions education and present a framework based on Malcolm Knowles' key components of self-directed learning.</p><p><b>RESULTS</b>The key components of self-directed learning are: the educator as a facilitator, identification of learning needs, development of learning objectives, identification of appropriate resources, implementation of the process, commitment to a learning contract and evaluation of learning. Several but not all of these components are often described in the published literature.</p><p><b>CONCLUSION</b>Although the presented framework provides some consistency for educators interested in applying SDL methods, future studies are needed to standardise self-directed learning curricula and to determine the effectiveness of these components on educational outcomes.</p>