Department of Medical Oncology, Kinki University School of Medicine, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan
*E-mail: mfukuoka@med.kindai.ac.jp
A 70-year-old man with adenocarcinoma of the lung developed pulmonary metastases 7 months after middle and lower lobectomy of the right lung in October 1998. He received four courses of first-line chemotherapy with docetaxel/irinotecan from June to September 1999. The best response was stable disease and, after 6 months of treatment, there was evidence of progressive disease with increase in size and number of pulmonary metastases. Therefore, we recommended enrollment in a phase I study of gefitinib (Iressa) [1], an orally active epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor.
The patient began to take gefitinib 700 mg/day in March 2000. Remarkable tumor regression was immediately achieved in April 2000 (Figure 1). This response lasted for 18 months. However, pulmonary metastases again developed (considered to be progressive disease), and gefitinib was discontinued in October 2001. The patient received a combination of nedaplatin, a second-generation platinum complex with high antitumor activity against non-small-cell lung cancer [2], and gemcitabine in November 2001. Significant tumor regression was achieved, and a total of six courses from November to April 2002 were administered. Pulmonary metastases progressed again and pulmonary effusion developed in August 2002. Although progressed, he had few symptoms, and was considered to have a performance status of 0. We planned to use a chemotherapy regimen that had not previously been used for this patient, but instead commenced re-treatment with gefitinib at the patients request on September 3, 2002 (gefitinib 250 mg/day had by this time been approved for use in Japan). One month later, a significant response had been achieved (Figure 1).
|
T. Kurata, K. Tamura, H. Kaneda, T. Nogami, H. Uejima, G. Asai, K. Nakagawa & M. Fukuoka**Department of Medical Oncology, Kinki University School of Medicine, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan (*E-mail: mfukuoka@med.kindai.ac.jp)
REFERENCES
1. Negoro S, Nakagawa K, Fukuoka M et al. Final results of a phase I intermittent dose-escalation trial of ZD1839 (Iressa) in Japanese patients with various solid tumors. Proc Am Soc Clin Oncol 2001; 20: 324a.
2. Kameyama Y, Okazaki N, Nakagawa M et al. Nephrotoxicity of a new platinum compound, 254-S, evaluated with rat kidney cortical slices. Toxicol Lett 1990; 52: 1524.[CrossRef][ISI][Medline]
3. Saltz L, Rubin M, Hochster H et al. Cetuximab (IMC-C225) plus irinotecan (CPT-11) is active in CPT-11-refractory colorectal cancer (CRC) that express epidermal growth factor receptor (EGFR). Proc Am Soc Clin Oncol 2002; 20: 3a.
4. Giaccone G, Johnson DH, Manegold C et al. A phase III clinical trial of ZD1839 (Iressa) in combination with gemcitabine and cisplatin in chemotherapy-naive patients with advanced non-small-cell lung cancer (INTACT 1). Ann Oncol 2002; 13 (Suppl 5): 2.
5. Johnson DH, Herbst R, Giaccone G et al. ZD1839 ("Iressa") in combination with paclitaxel and carboplatin in chemotherapy-naive patients with advanced non-small-cell lung cancer (NSCLC): results from a phase III clinical trial (INTACT 2). Ann Oncol 2002; 13 (Suppl 5): 127.