Based on the positive results of a recent clinical trial, the FDA approved afatinib for first-line treatment of patients with late-stage, non-small cell lung cancer (NSCLC) who have a mutation in the EGFR gene. The drug, which will be marketed under the name Gilotrif, is specifically intended for patients with two particular EGFR mutations: exon 19 deletion and exon 21 L858R substitution. The FDA also approved the therascreen EGFR RGQ PCR Kit, a companion diagnostic used to test for EGFR mutations. Afatinib differs from other EGFR inhibitors like erlotinib (Tarceva) and gefitinib (Iressa) in that it irreversibly destroys the EGFR protein, instead of just reversibly blocking it, and also inhibits several other related proteins.
Results from the LUX-Lung 3 clinical trial show that afatinib appears to be well tolerated and more effective than chemotherapy in patients with advanced non-small cell lung cancer (NSCLC) who have a mutation in the EGFR gene. Afatinib produced higher response rates and longer periods without cancer progression than cisplatin (Platinol) plus pemetrexed (Alimta), suggesting that it could be considered as a first-line therapy in advanced EGFR-mutant NSCLC. Afatinib, which is under priority review for approval by the FDA, may be effective in patients resistant to other EGFR inhibitors like erlotinib (Tarceva) and gefitinib (Iressa). However, no trials so far have directly compared afatinib with Tarceva or Iressa.
Results from a phase III clinical trial suggest that adding carboplatin (Paraplatin) to pemetrexed (Alimta) can improve outcomes in non-small cell lung cancer (NSCLC). Over 200 patients with advanced NSCLC received first-line treatment with Alimta either by itself or in combination with Paraplatin. The combination of the two chemotherapy agents extended the time before the cancer started growing again, and prolonged survival compared to Alimta alone. However, the combination treatment group had a higher incidence of serious side effects and four treatment-associated deaths.
OncoGenex Pharmaceuticals plans to launch two phase II clinical trials of its new cancer drug, OGX-427, in lung cancer patients. The Cedar trial will be conducted by the UK National Cancer Research Network and the UK Experimental Cancer Medicine Network at cancer centers throughout the UK. It will examine the effectiveness of OGX-427 in combination with chemotherapy in previously untreated patients with advanced squamous cell carcinoma (SCC) of the lung, a type of non-small cell lung cancer (NSCLC). The Spruce trial will be performed in the U.S. in collaboration with the Sarah Cannon Research Institute and will enroll patients with advanced non-squamous NSCLC. OGX-427 inhibits Hsp27, a protein that is overexpressed in many cancer cells.
The FDA has approved the use of erlotinib (Tarceva) as a first-line treatment for patients with advanced non-small cell lung cancer (NSCLC) who have a mutation in the EGFR gene. Tarceva, a tyrosine kinase inhibitor (TKI) that inhibits EGFR, had already been approved for patients with advanced NSCLC as a second- or later-line treatment if at least one chemotherapy regimen had failed, or as maintenance treatment if their disease had not progressed after four cycles of chemotherapy. At the same time, the FDA approved, for the first time, a test for EGFR mutations, the cobas EGFR Mutation test. The test enables doctors to identify which patients have EGFR mutations and are therefore candidates for first-line treatment with Tarceva, making it a so-called ‘companion diagnostic’ for Tarceva.
OncoGenex Pharmaceuticals announced that it will begin the Spruce clinical trial, a phase II study investigating the use of their cancer drug OGX-427 in non-small cell lung cancer (NSCLC). Patients with advanced non-squamous NSCLC will receive first-line treatment with chemotherapy using carboplatin (Paraplatin) and pemetrexed (Alimta), either with or without the addition of OGX-427. OGX-427 inhibits a protein called Hsp27, which is elevated in many cancers. The study investigators suggest that OGX-427 may be especially helpful for patients whose cancers lack certain mutations that would make them eligible for currently available targeted therapies.