http://www.100md.com
Tony Mok MD
Department of Clinical Oncology, The Chinese University of Hong Kong
Metastatic NSCLC is a highly fatal illness with minimal chance of long term survival. Recent developments in 3 rd generation cytotoxic chemotherapy, molecular targeted therapy and phamacogenomic have significantly prolonged survival and positively improved the quality of life. We have shifted from doing minimal for metastatic NSCLC to the new paradigm of optimization of treatment outcome with multiple lines of therapy. The bench mark results of third generation doublet are best represented by the 5 completed randomized studies (ECOG 1594, SWOG 9509, TAX 326, Scagliotti et al, Van Meerbeck et al) involving over 3700 patients. These studies confirmed not only that platinum-based novel drug regimens were equal in efficacy but also provided a reference standard for first line therapy. Subsequent development in epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) has further revolutionized management of advanced non-small cell lung cancer. Particularly in Asia , we observed high response rate and longer survival in selective groups of patients. Collective data of 31 published reports from Taiwan , Malaysia , Korea , China and Japan confirmed the tumor response rate of gelfitinib as second line therapy to be over 20% and disease control rate ranging from 30 to 70%. We observed a strong association of tumor response to non-smoker, female gender and adenocarcinoma. The findings also match the high incidence of EGFR mutation with patients holding these clinical characteristics. Despite the lack of survival benefit in ISEL subgroup analysis of the study has shown significant hazard ratio of 0.81, 0.67, 0.77 and 0.66 in adenocarcinoma, never smoker, female gender and oriental, respectively. EGFR-TKI is now one of the 2 nd or 3 rd line treatments for selective population in Asia . However, many questions remain unanswered. To develop this class of novel therapy as standard treatment for lung cancer patients we should address the following issues:
Department of Clinical Oncology, The Chinese University of Hong Kong
Metastatic NSCLC is a highly fatal illness with minimal chance of long term survival. Recent developments in 3 rd generation cytotoxic chemotherapy, molecular targeted therapy and phamacogenomic have significantly prolonged survival and positively improved the quality of life. We have shifted from doing minimal for metastatic NSCLC to the new paradigm of optimization of treatment outcome with multiple lines of therapy. The bench mark results of third generation doublet are best represented by the 5 completed randomized studies (ECOG 1594, SWOG 9509, TAX 326, Scagliotti et al, Van Meerbeck et al) involving over 3700 patients. These studies confirmed not only that platinum-based novel drug regimens were equal in efficacy but also provided a reference standard for first line therapy. Subsequent development in epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) has further revolutionized management of advanced non-small cell lung cancer. Particularly in Asia , we observed high response rate and longer survival in selective groups of patients. Collective data of 31 published reports from Taiwan , Malaysia , Korea , China and Japan confirmed the tumor response rate of gelfitinib as second line therapy to be over 20% and disease control rate ranging from 30 to 70%. We observed a strong association of tumor response to non-smoker, female gender and adenocarcinoma. The findings also match the high incidence of EGFR mutation with patients holding these clinical characteristics. Despite the lack of survival benefit in ISEL subgroup analysis of the study has shown significant hazard ratio of 0.81, 0.67, 0.77 and 0.66 in adenocarcinoma, never smoker, female gender and oriental, respectively. EGFR-TKI is now one of the 2 nd or 3 rd line treatments for selective population in Asia . However, many questions remain unanswered. To develop this class of novel therapy as standard treatment for lung cancer patients we should address the following issues: