Treating advanced non-small cell lung cancer – is gefitinib the solution?

This study looked at a new drug, gefitinib (Iressa), used for treating non-small cell lung cancer (NSCLC) that has spread from its original site.

A common treatment option for non-small cell lung cancer is chemotherapy. Many patients find the side effects of this treatment to be quite severe. The long-term outcomes for this treatment, such as survival rates, are often quite poor.

Common genetic mutations in non-small cell lung cancer (NSCLC), for example in the epidermal growth factor receptor (EGFR; a protein found on the surface of cells in the body), can often play a role in the growth of NSCLC. Treatments such as gefitinib are known as EGFR tyrosine-kinase inhibitors (EFGR-TKI). These drugs block the activity of the epidermal growth factor receptor, slowing tumor growth.

This paper reviewed how effective gefitinib was in treating adults with NSCLC that had spread. The authors reviewed 7 different studies including 1692 patients. All of the patients were treated with 250 mg of gefitinib per day. 

Overall, the reviewers found that gefitinib is an effective and generally well-tolerated treatment option for patients with NSCLC and EGFR mutations who have not received an EGFR TKI type drug previously.

In one study of 609 patients, the authors found that the time following treatment before the cancer started to progress (known as the progression free survival rate) was 9.5 months for patients with an EGFR mutation taking gefitinib and 6.3 months for patients receiving chemotherapy (carboplatin plus paclitaxel). The overall survival time (time from treatment until death from any cause) was almost the same for both groups.

When gefitinib was compared to other chemotherapy drugs (cisplatin plus docetaxel), the results were similar. There was a 51% reduction in the risk of disease progression for these patients. The overall survival of these patients were the same for each group.

Gefinitib was well-tolerated by most patients. The most common side effect was skin rash, seen in 49% of patients, compared to 10% of patients treated with chemotherapy. Diarrhea also occured more often with gefitinib (35% of patients) compared to chemotherapy (25% of patients). Low levels of white blood cells (the cells that help to fight infections) occured more often in patients treated with chemotherapy (74%) compared to gefitinib (5%).  

Interstitial lung disease (scarring of the lung tissue, a severe side effect) was seen in 1.3% of patients treated with gefitinib. 

This study concluded that gefitinib is an effective and safe treatment for patients with EGFR-positive NSCLC who have not been treated with EGFR-TKI.