Targeted Therapy in Advanced Non-Small-Cell Lung Cancer

Abstract

Molecularly targeted therapies have recently expanded the options available for patients with advanced non-small-cell lung cancer (NSCLC). Two cancer cell pathways in particular have been exploited, the epidermal growth factor receptor (EGFR) and the vascular endothelial growth factor (VEGF) pathway. The former has emerged as a key regulator of cancer cell proliferation and invasion, and several EGFR inhibitors have been developed. Erlotinib, a small-molecule inhibitor of the EGFR intracellular tyrosine kinase, has been found to improve survival compared with placebo in previously treated patients with advanced NSCLC and is Food and Drug Administration (FDA)-approved in this setting. Clinical and molecular predictors of response to erlotinib, such as a history of never smoking and EGFR gene mutation or amplification, are presently being evaluated to select patients for earlier therapy with erlotinib. Additional EGFR inhibitors are also being examined in randomized trials. The VEGF pathway, a key mediator of angiogenesis, has become an attractive target in multiple malignancies, including lung cancer. Bevacizumab, a monoclonal antibody to VEGF, received FDA approval for use in advanced non-squamous-cell NSCLC in 2006 after a phase III trial reported a significant survival advantage when bevacizumab was added to standard first-line chemotherapy. Small-molecule inhibitors of the VEGF receptor tyrosine kinase, such as sunitinib and sorafenib, have also shown promise in phase II trials and are being further investigated in phase III studies. Because preclinical data suggest a synergistic effect when VEGF and EGFR inhibitors are combined, the concurrent use of erlotinib and bevacizumab has additionally been evaluated in a phase II trial, with encouraging early results suggesting at least equivalent activity to standard salvage chemotherapy, with less toxicity. Several other novel agents are being examined, including inhibitors of histone deacteylases and the 26S proteosome. Research efforts are currently focusing on tailoring such therapies according to predictive clinical and molecular markers.

A Human Monoclonal Anti-ANG2 Antibody Leads to Broad Antitumor Activity in Combination with VEGF Inhibitors and Chemotherapy Agents in Preclinical Models

“…VEGF inhibitors have shown encouraging clinical activity, improving patient time to progression and survival across a number of clinical indications (6)(7)(8). The potential for 3.19.3 to be used in addition to these treatments without increasing toxicity holds promise for future trials, as the majority of patients receiving VEGF therapy will eventually stop treatment due to toxicity or disease progression (36)(37)(38)(39)(40). The mechanisms behind the enhanced activity observed in these preclinical models may be due to a more complete angiogenic blockade or may suggest that Ang2 and VEGF function independently to promote tumor angiogenesis.…”

Target therapy in NSCLC patients: Relevant clinical agents and tumour molecular characterisation

“…Inhibition of the EGFR pathway with tyrosine kinase inhibitors (TKIs) has proven to be an effective treatment Target therapy in NSCLC patients: Relevant clinical agents and tumour molecular characterisation (Review) strategy for advanced non-small cell lung cancer (NSCLC) (8)(9)(10). TKIs are a class of drugs that act on the EGFR ATP-binding site, leading to the reversible blocking of downstream signalling pathway activation.…”

Lessons learnt from gefitinib and erlotinib: Key insights into small-molecule EGFR-targeted kinase inhibitors in non-small cell lung cancer

“…Most patients present with advanced disease that is not amenable to curative surgery. Conventional chemotherapy and chemoradiation therapy are asso- [15,20]. EGFR, epidermal growth factor receptor.…”