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. 2012 Jul;4(4):173-81.
doi: 10.1177/1758834012440015.

Combining chemotherapy with epidermal growth factor receptor inhibition in advanced non-small cell lung cancer

Linda Leung  1 , Tony S K Mok, Herbert Loong
Affiliations

Combining chemotherapy with epidermal growth factor receptor inhibition in advanced non-small cell lung cancer

Linda Leung et al. Ther Adv Med Oncol. 2012 Jul.

Abstract

Treatment of advanced stage lung cancer is changing rapidly. With the new found knowledge on molecular targets such as the epidermal growth factor receptor (EGFR), effective therapy is now available in a selected population with the target mutation. Single-agent epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) is a standard first-line therapy for patients with activating-EGFR mutation such as base-pair deletion in exon 19 or point mutation at exon 21. At the same time, this class of drugs may be combined with chemotherapy. Studies on the concurrent combination of chemotherapy and EGFR-TKI confirmed a lack of efficacy. A phase II study on sequential intercalated combination has demonstrated an improvement in progression-free survival (PFS), but this needs to be validated by the ongoing phase III study. The third approach is to combine EGFR-TKI as maintenance therapy after tumour response or stable disease to cytotoxic chemotherapy. Two phase III studies have shown improvement in PFS, but the use of biomarkers for the selection of maintenance therapy remains debatable. Cetuximab is a monoclonal antibody against EGFR and its combination with chemotherapy was shown to improve overall survival in an unselected population. A new biomarker using the H-score will help to select patients for this combination.

Keywords: biomarker; crizotinib; epidermal growth factor receptor mutation; erlotinib; gefitinib; lung cancer; molecular targeted therapy.

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Conflict of interest statement

Conflict of interest statement: The authors declare no conflicts of interest in preparing this article.

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