March 21, 2008
There is “strong evidence” that selected groups of patients with advanced non-small cell lung cancer (NSCLC) may benefit from first-line therapy with an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, according to the authors of a report in the March issue of the Journal of Thoracic Oncology.
“Given the efficacy of EGFR tyrosine kinase inhibitors in advanced NSCLC in the salvage setting, along with their favorable toxicity profile compared with conventional chemotherapy, there is considerable interest in evaluating their efficacy in the first-line treatment for NSCLC,” write Dr. Ramaswamy Govindan from Washington University School of Medicine, St. Louis, Missouri and colleagues.
The researchers’ article summarizes the results of published phase II and III clinical trials that tested the efficacy of the EGFR inhibitors erlotinib (Tarceva) and gefitinib (Iressa) as first-line therapy for advanced NSCLC.
While the findings overall from four randomized phase III trials have been negative, there is strong evidence that some patients may be appropriate candidates for first-line EGFR-targeted therapies, Dr. Govindan and colleagues report.
“In particular, never-smokers seem to have promising overall and progression-free survival benefit from first-line EGFR tyrosine kinase inhibitor therapy alone or in combination with chemotherapy,” note the clinicians.
Patients with EGFR tyrosine kinase mutations and/or bronchioloalveolar cell carcinoma histology also seem to respond to first-line EGFR inhibitor therapy with results comparable to conventional chemotherapy.
“Nevertheless, whether these clinical or molecular features are valid prognostic or predictive markers can only be definitively ascertained through prospective randomized phase III studies,” Dr. Govindan and colleagues conclude. “Until then,” they add, “the use of erlotinib or gefitinib as first-line therapy for advanced NSCLC remains investigational.”
SOURCE:
J Thorac Oncol 2008.