Use of erlotinib or gefitinib as initial therapy in advanced NSCLC

Area of Science:

• Oncology
• Pharmacology

Background:

• Tyrosine kinase inhibitors (TKIs) targeting the epidermal growth factor receptor (EGFR) have shown efficacy in non-small-cell lung cancer (NSCLC).
• Erlotinib (Tarceva) is approved for previously treated NSCLC based on survival benefits.
• First-line use of TKIs in NSCLC has been largely experimental.

Purpose of the Study:

• To review data on erlotinib and gefitinib as initial therapy for NSCLC.
• To contextualize recent findings on first-line gefitinib in specific NSCLC populations.

Main Methods:

• Review of existing clinical trial data.
• Analysis of a large phase III randomized controlled trial comparing gefitinib to chemotherapy.
• Reference to ongoing phase III trials of erlotinib in EGFR mutant lung cancer.

Main Results:

• First-line gefitinib demonstrated superiority over combination chemotherapy in a selected NSCLC population (Asian, adenocarcinoma, light smoking history).
• The benefit of gefitinib was more pronounced in patients with EGFR mutations.
• Erlotinib is currently under investigation in ongoing randomized phase III trials for initial treatment of EGFR mutant lung cancer.

Conclusions:

• Recent data support the use of first-line gefitinib in specific NSCLC patient groups.
• EGFR mutation status is a critical factor in TKI efficacy for NSCLC.
• Further research is warranted to establish the role of erlotinib and gefitinib in the first-line treatment of NSCLC.