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Additional file 1. Socio-professional categories.

Additional file 4. Phylogenetic trees of A/H1pdm and A/H3 sequences.

Additional file 2. Primers and probes used for detection, subtyping and sequencing influenza virus*.

Background Randomised control trials (RCTs) show good overall survival (OS) for advanced lung adenocarcinoma patients is much dependent on subsequent-line of treatment upon disease progression on first-line treatment. However, not many studies look into such outcome in real-world setting. Aims To determine the impact of second-line treatment on OS for advanced lung adenocarcinoma patients who failed first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) or chemotherapy in the real world-setting. Methods A retrospective analysis of advanced lung adenocarcinoma patients who developed disease progression on first-line EGFR-TKI or chemotherapy treatmentat the University of Malaya Medical Centre from 1 st August 2010 to 31 th July 2014. Results Of 78 patients with EGFR mutant tumours and failed first-line EGFR-TKI, 23 patients (29.5%) received second-line chemotherapy while remaining 56 patients (70.5%) had best supportive care (BSC). Subgroup analysis showed that patients who received second-line chemotherapy had numerically better median OS (12.60 months) than those received BSC (9.03 months) (HR, 0.53; 95% CI, 0.24-1.21; p=0.134). Of 79 patients with EGFR wild-type tumours and failed first-line chemotherapy, 36 patients (45.6%) received second-line chemotherapy and 43 patients (54.4%) had BSC - the median OS for the former was 11.50 months and the latter was 5.47 months (HR, 0.58; 95% CI, 0.34-0.98; p=0.043). Conclusions In the real-world setting, second-line active treatment significantly prolonged the OS. The OS in this study was shorter than that in RCTS due to presence of co-morbidities, poorer ECOG performance at diagnosis and lower rate of second-line treatment.

Background Gefitinib and erlotinib are superior to chemotherapy in terms of progression-free-survival (PFS), objective response rate (ORR) and disease control rate (DCR)in patients with epidermal growth factor receptor (EGFR) mutant advanced lung adenocarcinoma. However, studies comparing the treatment efficacy of gefitinib versus erlotinib are lacking. Aims To compare the PFS, overall survival (OS), ORR and DCR of patients with EGFR mutant advanced lung adenocarcinoma receiving first-line gefitinib versus erlotinib in a real-world setting. Methods A retrospective study of patients with EGFR mutant advanced lung adenocarcinoma treated with first-line gefitinib 250 mg once daily versus erlotinib 150mg once dailyat the University of Malaya Medical Centre from 1st August 2010 to 31th July 2014. Results 80 patients (81.6%) received gefitinib and 18 patients (18.4%) received erlotinib as first-line treatment. There was no significant difference in terms of PFS [7.13 versus 6.03 months (HR, 0.73; 95% CI, 0.39 - 1.38; p=0.335)] or OS [10.97 versus 8.67 months (HR, 0.57; 95% CI, 0.27 – 1.22; p=0.148)] between the two treatment groups. Patients on first-line gefitinib had better ORR [45.0% versus 33.3% (OR, 1.94; 95% CI, 0.63 - 6.00; p=0.251)] but worse DCR [76.3% versus 94.4% (OR, 0.23; 95% CI, 0.03 - 1.93; p=0.175)] compared to patients on first-line erlotinib, but the differences were not statistically significant. Conclusions In a real-world setting, patients with EGFR mutant advanced lung adenocarcinoma treated with first-line gefitinib or erlotinib appeared to have similar PFS, OS, ORR and DCR. However, the apparent lack of differences could have been due to the small sample size.