Iressa / Gefitinib was the great white hope on the lung cancer scene about 6 years ago, then faded into obscurity for a while. The problem was that the ISEL study did not demonstrate that this oral chemotherapeutic agent ( a tyrosine kinase inhibitor) was better than placebo in terms of survival benefit. There was, however, evidence of tumour response. That is, tumours seemed to get smaller, but people didn't live longer.
Further studies have demonstrated benefit in more select patient groups - much to the relief, I am sure, of AztraZeneca. The drug has recently been licensed in Australia for use in patients with locally advanced or metastatic non-small cell lung cancer if their tumours express activating mutations of the epidermal growth factor (EGFR) tyrosine kinase.
The IPASS trial, conducted in Asia, demonstrated that, in patients with a previous light smoking or non-smoking history, who had mutations of the EGFR tyrosine kinase and who had not received previous chemotherapy, Iressa was superior to a combination of carboplatin/paclitaxel in terms of disease free survival (9.5 vs 6.3 months). The INTEREST trial demonstrated equivalency of Iressa when compared with docetaxal in patients with locally advanced or metastatic NSCLC who had previously received platinum-based chemotherapy.
It's noteworthy that Iressa is now indicated as a first line chemotherapy in appropriately selected patients (ie those meeting the above criteria). Tarceva/Erlotinib, another EGFR tyrosine kinase inhibitor, is still only licensed for patients whose NSCLC has progressed in spite of first-line platinum based chemotherapy (ie second line). As far as I am aware.
It is bound to become more clear, over the next few months / years, exactly which patients do benefit from these medications - and others like them. Perhaps this will even give us a clearer indication of prognosis in patients with lung cancer.
Andrew
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