O-109 Phase II trial of erlotinib in patients with bronchioloalveolarcarcinoma

[Therapeutic management of extensive bronchiolo-alveolar adenocarcinoma: chemotherapy or inhibitors of epidermal growth factor receptor tyrosine kinase?]

Although the 1999 WHO classification, revised in 2004 excludes stage IIIB-IV tumors from the definition of bronchioloalveolar carcinoma (BAC) because they are unresectable, the first international workshop (November 2004, New York) devoted to this tumor emphasized the continuum between the BAC as defined by the WHO and adenocarcinomas with a BAC-like component which presents similar epidemiological, biological, clinical, radiological, prognostic and therapeutic features. These observations led to the suggestion to no include stage IIIB-IV ADC-BAC in studies designed for other non-small-cell lung cancers. The purpose of this review was to analyze the results of prospective studies currently available concerning the treatment of stage IIIB-IV ADC-BAC. No evidence is available with combination regimens using platine. Monotherapy with paclitaxel appears to have efficacy similar to inhibitors of epidermal growth factor receptor tyrosine kinase (gefitinib and erlotinib) (TKI-EGFR). The tolerance profile is in favor of using TKI-EGFR. It would appear that tumors responding to paclitaxel and to TKI-EGFR correspond to different diseases. These observations point out the importance of further studies examining the proper strategy and to search for new compounds for the treatment of extensive ADC-BAC.

Epidermal growth factor receptor inhibition and non-small cell lung cancer

The majority of non-small cell (NSC) lung cancers express epidermal growth factor receptor (EGFR). Many studies have evaluated the clinical effect from targeted therapy achieved by blocking EGFR in patients with NSC lung cancer. Treatment of biologically unselected patients with NSC lung cancer with two reversible quinazole EGFR inhibitors, gefitinib and erlotinib, gave negative results in all controlled trials but one. Ten percent to 20% of patients with NSC lung cancers have somatic mutations in EGFR, and these patients have a significantly higher response rate (73%) to treatment with EGFR inhibitors than patients with wild-type EGFR (10%). Patients with Asian background, women, non-smokers, and patients with adenocarcinoma had higher response rates than other patients, and the differences may be due to an association between the clinical characteristics and EGFR mutations. Further studies are needed to fully evaluate the effect of EGFR inhibitor-treatment for subgroups of patients with NSC lung cancer with favorable biological and clinical characteristics.