First-line Iressa® Benefits EGFR-positive Patients with Advanced NSCLC

Cancer Connect

First-line Iressa® (gefitinib) provides benefit to patients with advanced nonsmall cell lung cancer (NSCLC) who have epidermal growth factor receptor (EGFR) mutations and an extremely poor performance status, according to the results of a study published in the Journal of Clinical Oncology.[[1]]( "_ednref1")

Nonsmall cell lung cancer (NSCLC) accounts for roughly 85% of all lung cancer. In advanced NSCLC cancer has spread outside the lung. Standard therapy for this stage of disease typically includes chemotherapy; however, for patients who have a poor performance status (PS), there is no standard treatment other than best supportive care; most patients die within three to four months.

Human epidermal growth factor receptor (EGFR) is a protein that is found on the surface of cells and is involved in cellular growth, spread, and replication. Cancerous cells often overexpress EGFR or have mutations within EGFR, leading to uncontrolled growth or spread of the cancer cells.

Iressa is an oral agent that is targeted specifically against EGFR. Iressa binds to EGFR and halts or reduces its effects on cancer cells. Iressa has been shown to be less toxic than other chemotherapy agents and as such, researchers speculated that it might benefit patients with a poor PS who would typically be unable to receive chemotherapy.

Researchers from Japan conducted a study that included 30 patients with advanced NSCLC and a poor PS (including 22 patients with a PS of 3 to 4, with 4 being the worst). The patients were ages 20 to 74 and had EGFR mutations. They received 250 mg of Iressa administered orally once daily and continued treatment until they experienced disease progression or intolerable toxicity. (Patients who experienced severe toxicity could receive a modified dosing schedule of every other day.)

The results indicated that the overall response rate was 66% and the disease control rate was 90%. Furthermore, there as a PS improvement rate of 79%, with 68% of the 22 patients improving from a PS ? 3 at baseline to a PS ? 1. The median progression-free survival was 6.5 months, median survival time was 17.8 months, and the one-year survival rate was 63%. There were no treatment-related deaths.

The researchers concluded: This is the first report indicating that EGFR mutation-positive patients with extremely poor PS benefit from first-line Iressa. Because there previously has been no standard treatment for these patients with short life expectancy other than best supportive care, examination of EGFR mutations as a biomarker is recommended in this patient population.


[[1]]( "_edn1") Inoue A, Kobayashi K, Usui K, et al. First-line gefitinib for patients with advanced non-small cell lung cancer harboring epidermal growth factor receptor mutations without indication for chemotherapy. Journal of Clinical Oncology. 2009; 27: 1394-1400.

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