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  • Home > Blog > Treatment News > Presence of Tumor Growth Factors in Lung Cancer and Mesothelioma Could Determine Best Chemotherapy Treatment
Posted on Wednesday, Apr 20, 2011

Presence of Tumor Growth Factors in Lung Cancer and Mesothelioma Could Determine Best Chemotherapy Treatment

Pleural mesothelioma, a form of lung cancer that affects the lining of the lungs caused by exposure to asbestos, is highly aggressive and does not always respond to standard cancer treatments.  Both lung cancer and mesothelioma have proven to be chemoresistant at times, rendering many of the current chemotherapy treatments inadequate.   

This month the American Society of Clinical Oncology (ASCO) released a provisional clinical opinion (PCO) stating that by first determining whether advanced non-small-cell lung cancer (NSCLC) patients, and likely mesothelioma patients, have mutations of the epidermal growth factor receptor (EGFR) gene, oncologists can select a chemotherapy drug that may be better suited to treat the disease.

EGFR is a protein found on the surface of some cells to which epidermal growth factor binds, which causes the cells to divide and spread. It is found at abnormally high levels on the surface of many types of cancer cells.  According to a 2009 article in Current Drug Targets, EGFR overexpression has been shown in more than 50% of pleural mesothelioma patients, and ASCO identified approximately 15% of patients with lung cancer in the U.S. expressing EGFR mutations.

The ASCO researchers found that rather than using combination chemotherapy, which is often the preferred treatment for NSCLC and mesothelioma,  patients with EGFR may benefit from treatment with EGFR tyrosine kinase inhibitors (TKIs), such as, gefitinib (Iressa®, Astra Zeneca Pharmaceuticals) and erlotinib (Tarceva®, Genentech Inc).  To date, however, neither of these agents has been approved by the FDA for first-line therapy of lung cancer.

Based on results from a series of trials involving first-line EGFR TKIs and chemotherapy combination treatments, ASCO found that patients with EGFR-mutated NSCLC have a significantly higher rate of partial responses to the EGFR TKIs gefitinib and erlotinib.  Inhibitors may prevent the growth of new blood vessels that tumors need to grow and may kill cancer cells.

The PCO concludes “On the basis of the results of five phase III randomized controlled trials, patients with NSCLC who are being considered for first-line therapy with an EGFR TKI (patients who have not previously received chemotherapy or an EGFR TKI) should have their tumor tested for EGFR mutations to determine whether an EGFR TKI or chemotherapy is the appropriate first-line therapy.”  Although there are differences between lung cancer and mesothelioma, the treatments are often very similar and this PCO may be pertinent for mesothelioma treatment as well.

ASCO states that “the Provisional Clinical Opinion (PCO) is not intended to substitute for the independent professional judgment of the treating physician. Practice guidelines and PCOs do not account for individual variation among patients and may not reflect the most recent evidence. The PCO does not recommend any particular product or course of medical treatment. Use of the PCO is voluntary.”

EGFR Testing Recommended for Lung Cancer