Dr. Nathan Pennell, Cleveland Clinic, describes other options for treatment of acquired resistance, including chemotherapy, ablation with SBRT and a combination of Gilotrif and Erbitux.
Drs. Jack West and Greg Riely field questions about which treatments should EGFR lung cancer patients consider when their cancers progress.
Dr. Jack West suggests that progression in T790M-negative EGFR lung cancer patients may not require a change in therapy. In this video he details what should go into the decision to modify treatment for those patients.
The course of Erbitux (cetuximab), the antibody to EGFR, in lung cancer over the last years has been controversial but overall underwhelming. Added to carboplatin and Taxol (paclitaxel) or Taxotere (docetaxel) as first line therapy in a North American phase III randomized trial, it was associated with a marginal improvement in progression-free survival depending on who did the assessement, but no improvement in overall survival.
RTOG 0617: Stunningly Worse Survival for High Dose Radiation in Locally Advanced NSCLC, but Carbo-Taxol Has Never Looked Better
The Radiation Therapy Oncology Group (RTOG) has been working on a large randomized trial in patients with stage III, locally advanced, unresectable NSCLC that asked two key questions:
1) is the best dose of radiation the "old" standard of 60 Gray (Gy), over about 6 weeks, or a higher dose of 74 Gy that has been found to be feasible?
2) Is there a value in adding weekly Erbitux (cetuximab), the antibody to the epidermal growth factor receptor (EGFR), along with weekly carboplatin/Taxol (paclitaxel) and concurrent chest radiation therapy (RT)?
More Info on the Correlation of Rash with Outcome on EGFR Inhibitors: My Changing View in Light of the TOPICAL Trial
There's been a theme with the inhibitors of the epidermal growth factor receptor (EGFR) -- both oral tyrosine kinase inhibitors (TKIs) and IV monoclonal antibodies -- that the patients who demonstrate good results with these agents tend to get a rash, while the patients who don't get a rash do poorly.
Apologies for the long wait since our own Dr. Weiss's upbeat and thoughtful review of the leading stories about lung cancer in 2011. Dr. Weiss covered a lot of ground in his presentation that was followed by a Q&A session, so we've broken that up into several short pieces that cover a few highlights at a time.
The FLEX trial, a European study of cisplatin/Navelbine (vinorelbine) with or without the monoclonal antibody against EGFR Erbitux (cetuximab), was a technically positive study that was initially reported at ASCO 2008. However, showing an improvement in median survival of just 1.2 months, most oncologists came away feeling that the trial illustrated the difference between a statistically vs.
The Importance of Identifying Molecular Markers in Non-Small Cell Lung Cancer
EGFR stands for epidermal growth factor receptor, which is a molecule on the surface of many cancer cells that can be activated to activate signals that promote cell growth and cell division. Though this target may play a role for many kinds of cancer, non-small cell lung cancer (NSCLC) is one type in which this target protein is seen in a majority of people's cancers.