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ZD6474--clinical experience to date
1Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115, USA. John_Heymach@dfci.harvard.edu
Abstract:
ZD6474 selectively targets two key pathways in tumour growth by inhibiting vascular endothelial growth factor (VEGF)-dependent tumour angiogenesis and epidermal growth factor (EGF)-dependent tumour cell proliferation and survival. Phase I clinical evaluation has shown ZD6474 to be generally well tolerated, with a pharmacokinetic profile appropriate for once-daily oral dosing. Phase II evaluation of ZD6474 at doses of 100-300 mg is ongoing in a range of patient types in single and combination regimens. These include three randomised studies of patients with non-small-cell lung cancer. In one of these trials, the efficacy of ZD6474 monotherapy is being compared with that of the EGF receptor tyrosine kinase inhibitor gefitinib (Iressa) in previously treated patients. In the other two trials, the efficacy of ZD6474 in combination with certain standard chemotherapy regimens is being compared with that of standard chemotherapy alone: one with carboplatin and paclitaxel in previously untreated patients, and the second with docetaxel in patients who progressed after platinum-containing therapy. The advent of novel molecular-targeted agents such as ZD6474 has necessitated a re-evaluation of conventional cancer study design in order to optimise appraisal of this new generation of anticancer agents. The specific considerations of the ZD6474 clinical programme are discussed.
Insights
ZD6474, a novel agent, targets tumor growth by inhibiting vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) pathways. Ongoing Phase II trials evaluate its efficacy in non-small-cell lung cancer patients.
Area of Science:
- Oncology
- Pharmacology
- Molecular Biology
Background:
- Tumor growth is driven by angiogenesis and cell proliferation.
- Vascular Endothelial Growth Factor (VEGF) and Epidermal Growth Factor (EGF) are key signaling molecules.
- Targeted therapies offer new approaches to cancer treatment.
Purpose of the Study:
- To evaluate the safety and efficacy of ZD6474, a dual inhibitor of VEGF and EGF pathways.
- To assess ZD6474 in monotherapy and combination regimens for non-small-cell lung cancer (NSCLC).
- To explore optimal clinical trial designs for molecularly targeted agents.
Main Methods:
- Phase I clinical evaluation of ZD6474 for safety and tolerability.
- Phase II randomized trials in NSCLC patients comparing ZD6474 monotherapy vs. gefitinib.
- Phase II trials evaluating ZD6474 in combination with chemotherapy (carboplatin/paclitaxel or docetaxel).
Main Results:
- Phase I showed ZD6474 to be generally well tolerated with suitable pharmacokinetics for daily oral dosing.
- Phase II trials are ongoing, assessing ZD6474 in various NSCLC patient populations and treatment settings.
- Efficacy data from ongoing trials will determine ZD6474's role in NSCLC treatment.
Conclusions:
- ZD6474 demonstrates a promising safety profile and targets critical tumor growth pathways.
- Ongoing clinical trials will elucidate the therapeutic potential of ZD6474 in NSCLC.
- The development of ZD6474 highlights the need for adaptive clinical trial designs for targeted cancer therapies.
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