Rash Developed During Chemotherapy Linked to Survival in Lung Cancer Patients, May Eventually Lead to New Mesothelioma Treatment
Researchers reported in the December 20th issue of The Lancet Oncology that they have linked a skin rash to longer survival in non-small cell lung cancer (NSCLC) patients receiving a cisplatin/vinorelbine combination of chemotherapy followed by cetuximab (Erbitux). This finding may be significant for mesothelioma patients as ongoing clinical trials for both vinorelbine and cetuximab as a treatment for mesothelioma focus on finding effective and personalized treatments for the rare, aggressive cancer linked to asbestos exposure.
Current Mesothelioma Chemotherapy Treatment
Malignant Peural Mesothelioma (MPM), found in the outer lining of the lungs called the mesothelium, is resistant to many standard cancer treatments and is said to be chemo-resistant as well, making it a difficult disease to treat. While pleural mesothelioma is not classified as a lung cancer according to the medical definition, the treatments between lung cancer and pleural mesothelioma are often similar.
Clinical studies of vinorelbine have identified it as being among the most active agents for mesothelioma treatment; however, the drug is not yet approved for use in the treatment of mesothelioma. The combination of gemcitabine and cisplatin is one of the most common chemotherapy treatments for mesothelioma patients.
Clinical Trial Results
The clinical trial sponsored by Merck KGaA, included patients with a diagnosis of histologically or cytologically confirmed NSCLC, stage IIIb with a documented malignant pleural effusion or stage IV, but who had not had any previous chemotherapy for NSCLC.
The researchers found in their phase 3 First-Line Erbitux in Lung Cancer (FLEX) study that patients who developed rash during the first cycle of therapy lived almost twice as long as patients who received cetuximab but did not develop the rash. The rash was identified as a side effect of the treatment. Side effects from cisplatin treatment in mesothelioma patients are common and include low blood cell counts, thinned or brittle hair, loss of appetite or weight and stomach distress.
The researchers speculate that the results could be attributed either to the fact that a rash predicts cetuximab’s effectiveness or that the skin rash is a prognostic marker that identifies a group of patients who survive longer regardless of treatment with cetuximab.
Cetuximab is an epidermal growth factor receptor (EGFR) inhibitor. EGFR is a protein found on the surface of some cells to which epidermal growth factor binds, which causes the cells to divide. It is found at abnormally high levels on the surface of many types of cancer cells.
Rash and other cutaneous adverse events are “a class effect of EGFR inhibitors,” and data from some studies have suggested that rash might predict the efficacy of EGFR-targeting therapy.
Further analysis is needed to determine the impact of the study on the treatment of lung cancer or mesothelioma.
