gms | German Medical Science

Here we describe in detail clinical experience with Erlotinib, a new tyrosine-kinase-inhibitor, in the treatment of advanced non-small call lung cancer.

We included 41 patients (male 61%, female 39%; 80% with a history of smoking) over a period of 9 month in the Tarceva®-EAP. Of them, nearly 56% were suffering from adeno-carcinoma, 24% from squamous-cell-carcinoma and 20% of other types of carcinoma like alveolar cell carcinoma or large cell. Erlotinib was used as a first line treatment in 32%, in second line in 27% and in third line in 41% of the patients, with median ages of 75, 68 and 58 years, respectively.

In 27% of the patients, a statement concerning the response to the treatment was not possible, either due to death within a short time (a few days) after therapy with Erlotinib started or due to other reasons. For the remaining 30 patients, treatment with Erlotinib resulted in more than 60% of patients in partial remission (9.3%) or at least in a stable disease with a median survival time of about 10 months. However, there are certain differences in the response-rates depending on the histology of the cancer and smoking behavior. While in non-smokers the median survival rate was reached within 9 weeks and in patients with carcinoma other than adeno-type within 15 weeks, in smokers and in patients with adeno-carcinoma the median survival was not reached after 40 weeks now. However, since there is a relevant number of patients with other types of lung-cancer than adeno-carcinoma, who response very well to Erlotinib, the treatment should not be restricted a priori to a certain group of patients.

In general Erlotinib was well tolerated. The major side-effect was a rash, occurring in more than 75% of the patients, which may be treated with topic steroids or antibiotics or naturopathic methods like wraps with black tea or certain “Schüssler-Salze”. In less than 10% a reduction of dosage was necessary due to a grade 3/4 side-effect. Another expected side-effect was diarrhea, which occurred in less than 10% of the patients. It is remarkable, that 6% of the patients mentioned an at least grade 2 alopecia, setting in about 4-6 weeks after treatment with Erlotinib started, a side-effect, that was not found in the BR.21-study.

In summary Erlotinib represents a sufficient medication in patients with advanced non-small cell lung cancer in first-line treatment as well as in pretreated patients.