LSU oncologist Vince D. Cataldo, MD, is the lead author of a review article reporting two chemotherapy drugs now indicated for second and third-line therapy in patients with advanced non-small-cell lung cancer are remarkably effective in treating a certain subset of these patients. Dr. Cataldo, a Clinical Assistant Professor of Medicine at LSU Health Sciences Center New Orleans School of Medicine, practicing at LSU's Earl K. Long Medical Center and Hematology-Oncology Clinic in Baton Rouge, and his colleagues say these drugs should be considered as a first-line treatment in people who are known to carry an Epidermal Growth Factor Receptor (EGFR) mutation. The paper is published in the March 10, 2011 issue of the New England Journal of Medicine.
The drugs, Erlotinib and Gefitinib, which are in a class of highly-specific small molecule tyrosine kinase inhibitors, work by blocking the activation of EGFR which is involved in cell survival and growth, as well as the development of a nourishing blood supply and metastasis.
"Targeting the genetic mutation contributing to the development of the cancer, this class of drugs produced a response rate that exceeded 70% in these patients," notes Dr. Cataldo.
The drugs, taken by mouth, also had fewer side effects. Unlike traditional cytotoxic agents, Erlotinib and Gefitinib do not typically cause myelosuppression, neuropathy, alopecia, or severe nausea.
Lung cancer, the leading cause of cancer-related death worldwide, accounted for an estimated 157,300 deaths in the United States in 2010. Approximately 85 to 90% of all cases of lung cancer are non-small-cell lung cancer (NSCLC) which is also associated with smoking. Advanced-stage NSCLC is currently considered an incurable disease for which standard chemotherapy provides marginal improvement in overall survival at the expense of substantial morbidity and mortality. Furthermore, less than 30% of patients with metastatic NSCLC have a response to platinum-based chemotherapy, the most commonly used initial treatment in this stage of the disease. Even with the addition of newer agents, such as bevacizumab, to chemotherapy, the median overall survival of patients with metastatic NSCLC remains approximately 1 year, and only 3.5% of patients with metastatic NSCLC survive 5 years after diagnosis.
"The EGFR mutation is just one of the mutations associated with non-small-cell lung cancer," says Dr. Cataldo. "These results also provide a model for identifying others, which we are currently pursuing. Treatment targeting the causes of this cancer will not only improve quality of life, but may also improve survival of this devastating disease."
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