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Epidermal Growth Factor Receptor Inhibition in Lung Cancer – Lessons Learned

A Resident Education Article

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Current Oncology Volume 19, No. 1

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by Barbara Melosky, MD

The use of epidermal growth factor receptor (EGFR) inhibitors has now been standard of care for several years but it is important to review the history of how we got to where we are. Unlike many other situations in drug development and clinical practice, here the science and biomarker understanding followed the clinical use by many years.

 

An open access program with gefitinib, an EGFR tyrosine kinase inhibitor (TKI), in early 2000 allowed many oncologists across the country to gain experience in their patients with advanced non-small cell lung cancer. In patients with poor performance status, the toxicity was very different than chemotherapy and dramatic responses could occur. The dose we were using was not the determined dose of 500 mg from Phase 1 studies, but 250 mg as this lower dose seemed to have the same efficacy from two large Phase 2 randomized trials IDEAL 1 and IDEAL 2 and was better tolerated1, 2.

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Oncology Rehabilitation for the Lung Cancer Survivor

by Deborah J. Doherty, PT, PhD, CEAS

With thanks to Priyanka Parab

Oncology rehabilitation is one of the fastest-growing fields in oncology, and it is desperately needed across the continuum of care. The quality of life of cancer survivors is now a major focus as survivorship numbers grow rapidly. Whether in prevention, pre-op care, post-op in-patient care, out-patient care, supervised group exercise or palliative and hospice care, Oncology Rehabilitation has a role.

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On Becoming a Mother

 

by Sarah A.O. Isenberg

 

My daughter and I are a lot alike. She’s a Type-A personality. She smiles easily and loves to laugh. She’s highly social. She enjoys moving her body. She loves to learn. She has long, dark-brown hair and brown eyes.

 

But my husband and I are Caucasian, and our daughter is Chinese-American. And my daughter wasn’t born from my body. She has a birth mother, somewhere. How we came together and how much we are alike, even from the beginning, before nurture could get in the way, is just miraculous. Unforeseen circumstances and critical people almost prevented it from happening. Why? No felonious past, no abusive present. Plenty of love and resources to bestow. Then why? Because I had been diagnosed with cancer.

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Adventure of Hope

by Terri Wingham

 

Two years ago, the words, “you have cancer” changed my life forever. At the age of 30, fighting cancer was physically draining and emotionally exhausting. But, no one prepared me for how hard it would be to pick up the pieces of my pre-cancer life and move forward after treatment ended.

 

When I walked out of the hospital after my final surgery in January of 2011, a nurse told me how to dress my wounds, but no one told me how to cope with the challenging emotions I faced on my way to survivorship. Well-meaning friends and family talked endlessly about how excited I must be for treatment to be over. But I didn’t feel excited.

 

Like many of the 12+ million cancer survivors in North America, I felt trapped in a post-treatment void. I had lost my sense of belonging to my pre-cancer world, my connection to myself and to my friends and family, and my sense of certainty about life. The support during my diagnosis and treatment faded, and I was left alone with my fears of recurrence, my worries about how returning to a stressful job could increase my risk of developing a secondary cancer, and my sense of loss over my breasts and my carefree past.

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Response to second-line erlotinib in an EGFR mutation-negative patient with non-small-cell lung cancer: make no assumptions

by I. Karam, B. Melosky

Abstract

Erlotinib—an oral tyrosine kinase inhibitor (TKI) of the epidermal growth factor receptor (EGFR)— has commonly been used as a therapeutic option in metastatic non-small-cell lung cancer (NSCLC) patients in the second- or third-line treatment setting. A mutation in the EGFR gene (EGFR M+) confers an increased response to this class of drugs. In the first-line setting, use of tkis is restricted to patients having a mutation. The importance of this biomarker has been questioned in subsequent treatment lines.

Here, we report a case showing a positive response to erlotinib treatment in the second-line setting. The patient, an elderly male smoker with stage IV NSCLC, had a tumour that was EGFR mutation- negative (wild-type EGFR). Based on this clinical case, we discuss the controversy concerning the need for, and impact of, testing for EGFR mutation after first-line treatment.

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