Improved Second Line Therapy for Lung Cancer

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By Roy Herbst, M.D., Ph.D.
Professor in the Department of Thoracic/Head and Neck Medical Oncology

Herbst1.jpgToday at ASCO in an oral session, I reported on the improved second line therapy for lung cancer.  Vandetinib is an oral, dual tyrosine kinase inhibitor that inhibits both the epidermal growth factor receptor (EGFR) and the vascular growth factor receptor (VEGFR).  This agent was studied in a 1391 patient trial which demonstrated an improved time to disease progression and improved quality of life in patients who received the vandetinib and the docetaxel, which is a standard, second-line agent.  The hazard ratio for benefit was .79 which demonstrates a 21 percent improvement. Importantly looking at lung cancer symptoms there was a significantly increased time for patients to develop symptoms.  No difference was seen in overall survival though this endpoint was potentially compromised by the fact that about 50 percent of patients on each arm received one or more chemotherapy regimens after the trial.

 One other important factor was that this trial was open to patients with all lung cancer histologies (including squamous cell tumors) where benefits were also seen at the same rate.  Finally this regimen was well tolerated with rash being the only major side effect-  There were no issues at all with bleeding from the lung (hemoptysis) which has been seen with other agents of this class.

 This is a small step forward in lung cancer therapy.  It is my hope that a better understanding of molecular prognostic factors, such as we are developing in our BATTLE program, will enable us someday to find populations of patients who might benefit even more from this treatment

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