Targeted drug delays relapse of intermediate-stage lung cancer

A drug holds lung cancer at bay longer after surgery than standard chemotherapy, according to unpublished results of a new trial in China.

Patients in the trial were treated with gefitinib (Iressa), a drug that targets a faulty version of a molecule found on surface of some lung cancer cells called epidermal growth factor receptor (EGFR). These patients experienced a longer time without their lung cancer coming back after surgery than patients who received standard treatment.

Those who received the targeted drug also reported fewer serious side effects.

Professor Charles Swanton, from the Francis Crick Institute in London, part-funded by Cancer Research UK, said that the improvements were exciting and may lead to a change in how some lung cancer patients are treated.

The phase III clinical trial included 222 patients with intermediate stage non-small cell lung cancer (NSCLC) whose tumours carried a faulty version of the EGFR molecule, and who had previously had surgery. Half received gefitinib and half received standard chemotherapy (the drugs vinorelbine and cisplatin).

According to results of the study, which will be presented at the upcoming 2017 ASCO Annual Meeting in Chicago in the US, patients who received gefitinib went about 10 months longer after surgery without their cancer coming back than patients treated with chemotherapy.

The average time that tumours returned was 28.7 months for patients who received gefinitib and 18 months for those who received chemotherapy.

While nearly half of the patients who received chemotherapy experienced serious side effects, only around 1 in 10 of the patients who received gefitinib did.

NSCLC makes up the majority of the cases of lung cancer in the UK. Due to high chance of recurrence only around 4 in 10 patients with stage II-IIIA NSCLC survive for 5 years or more.

The UK drugs regulator NICE recommends gefitinib as a possible first treatment for some patients with advanced NSCLC or if the disease has spread. But Swanton said that previously there had been no evidence that this type of drug, called a tyrosine kinase inhibitor, would help lung cancer patients with EGFR faults.

“But by looking specifically for patients who have a faulty version of the gene that makes them more susceptible to tyrosine kinase inhibitors, the results suggest that these drugs will benefit some patients,” he added.

The study’s lead author, Dr Yi-Long Wu from the Guangdong Lung Cancer Institute in China, said that it would be important to continue to monitor the patients from the trial to assess overall survival.

ASCO president elect Dr Bruce Johnson added that the study gives evidence that precision medicine can be used with earlier stage disease, as well as those with advanced cancer.