Effective Ultra-low Doses of Erlotinib in Patients with EGFR Sensitising Mutation

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2014 Jul 25

PMID 25056302

Citations 1

Authors

Weronika Maria Szejniuk

Tine McCulloch

Oluf Dimitri Roe

Affiliations

Soon will be listed here.

Abstract

We describe three cases of patients with advanced adenocarcinoma of the lung and epidermal growth factor receptor (EGFR) mutation treated with erlotinib 25 mg/day and 25 mg every second day, being equal to one-sixth and one-twelfth of the recommended dose. The mean age of our patients was above 70 with a WHO performance status 1 before and during the treatment. The reasons for erlotinib dose reduction were rash, diarrhoea and fatigue. The decision was a result of lack of other treatment options and radiological response on standard doses. We did not observe any liver enzyme abnormalities. However, the post-treatment creatinine increased significantly. As of February 2014, our patients are still on treatment with tolerable side effects and improved quality of life. These findings indicate that some patients responding to erlotinib with noxious side effects could have clinical benefit in doses much lower than recommended.

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References

Shepherd F, Pereira J, Ciuleanu T, Tan E, Hirsh V, Thongprasert S . Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005; 353(2):123-32. DOI: 10.1056/NEJMoa050753. View

Goldstraw P, Crowley J, Chansky K, Giroux D, Groome P, Rami-Porta R . The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007; 2(8):706-14. DOI: 10.1097/JTO.0b013e31812f3c1a. View

Kelly R, Billemont B, Rixe O . Renal toxicity of targeted therapies. Target Oncol. 2009; 4(2):121-33. DOI: 10.1007/s11523-009-0109-x. View

Petrelli F, Borgonovo K, Cabiddu M, Lonati V, Barni S . Relationship between skin rash and outcome in non-small-cell lung cancer patients treated with anti-EGFR tyrosine kinase inhibitors: a literature-based meta-analysis of 24 trials. Lung Cancer. 2012; 78(1):8-15. DOI: 10.1016/j.lungcan.2012.06.009. View

Lindeman N, Cagle P, Beasley M, Chitale D, Dacic S, Giaccone G . Molecular testing guideline for selection of lung cancer patients for EGFR and ALK tyrosine kinase inhibitors: guideline from the College of American Pathologists, International Association for the Study of Lung Cancer, and Association for Molecular.... J Mol Diagn. 2013; 15(4):415-53. DOI: 10.1016/j.jmoldx.2013.03.001. View

Bronte G, Rolfo C, Giovannetti E, Cicero G, Pauwels P, Passiglia F . Are erlotinib and gefitinib interchangeable, opposite or complementary for non-small cell lung cancer treatment? Biological, pharmacological and clinical aspects. Crit Rev Oncol Hematol. 2013; 89(2):300-13. DOI: 10.1016/j.critrevonc.2013.08.003. View

Yeo W, Riely G, Yeap B, Lau M, Warner J, Bodio K . Erlotinib at a dose of 25 mg daily for non-small cell lung cancers with EGFR mutations. J Thorac Oncol. 2010; 5(7):1048-53. PMC: 2893286. DOI: 10.1097/JTO.0b013e3181dd1386. View

Ou S . Lung cancer in never-smokers. Does smoking history matter in the era of molecular diagnostics and targeted therapy?. J Clin Pathol. 2013; 66(10):839-46. DOI: 10.1136/jclinpath-2012-201296. View

Gridelli C, Maione P, Galetta D, Rossi A . Safety profile of erlotinib in patients with advanced non-small cell lung cancer with chronic renal failure. J Thorac Oncol. 2007; 2(1):96-8. DOI: 10.1097/JTO.0b013e31802bffb0. View

10.

Li J, Zhao M, He P, Hidalgo M, Baker S . Differential metabolism of gefitinib and erlotinib by human cytochrome P450 enzymes. Clin Cancer Res. 2007; 13(12):3731-7. DOI: 10.1158/1078-0432.CCR-07-0088. View

11.

Hidalgo M, Siu L, Nemunaitis J, Rizzo J, Hammond L, Takimoto C . Phase I and pharmacologic study of OSI-774, an epidermal growth factor receptor tyrosine kinase inhibitor, in patients with advanced solid malignancies. J Clin Oncol. 2001; 19(13):3267-79. DOI: 10.1200/JCO.2001.19.13.3267. View

12.

Sacher A, Le L, Leighl N, Coate L . Elderly patients with advanced NSCLC in phase III clinical trials: are the elderly excluded from practice-changing trials in advanced NSCLC?. J Thorac Oncol. 2013; 8(3):366-8. DOI: 10.1097/JTO.0b013e31827e2145. View

13.

Thatcher N, Chang A, Parikh P, Pereira J, Ciuleanu T, von Pawel J . Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer). Lancet. 2005; 366(9496):1527-37. DOI: 10.1016/S0140-6736(05)67625-8. View

14.

Cooper W, Lam D, OToole S, Minna J . Molecular biology of lung cancer. J Thorac Dis. 2013; 5 Suppl 5:S479-90. PMC: 3804875. DOI: 10.3978/j.issn.2072-1439.2013.08.03. View

15.

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

16.

Cohen M, Johnson J, Chen Y, Sridhara R, Pazdur R . FDA drug approval summary: erlotinib (Tarceva) tablets. Oncologist. 2005; 10(7):461-6. DOI: 10.1634/theoncologist.10-7-461. View

17.

Peters S, Adjei A, Gridelli C, Reck M, Kerr K, Felip E . Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012; 23 Suppl 7:vii56-64. DOI: 10.1093/annonc/mds226. View

18.

Takashima N, Kimura T, Watanabe N, Umemura T, Katsuno S, Arakawa K . Prognosis in patients with non-small cell lung cancer who received erlotinib treatment and subsequent dose reduction due to skin rash. Onkologie. 2012; 35(12):747-52. DOI: 10.1159/000345039. View

19.

Meoni G, Cecere F, Lucherini E, Di Costanzo F . Medical treatment of advanced non-small cell lung cancer in elderly patients: a review of the role of chemotherapy and targeted agents. J Geriatr Oncol. 2013; 4(3):282-90. DOI: 10.1016/j.jgo.2013.04.005. View

20.

Szumera-Cieckiewicz A, Olszewski W, Tysarowski A, Kowalski D, Glogowski M, Krzakowski M . EGFR mutation testing on cytological and histological samples in non-small cell lung cancer: a Polish, single institution study and systematic review of European incidence. Int J Clin Exp Pathol. 2013; 6(12):2800-12. PMC: 3843260. View