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Erbitux Fights Advanced Lung Cancer

Study Shows Drug May Add New Option for Treatment of Lung Cancer Patients

Medically Reviewed by Louise Chang, MD on June 02, 2008
From the WebMD Archives

June 1, 2008 (Chicago) -- Adding the drug Erbitux to standard chemotherapy extends the lives of advanced lung cancer patients by about five weeks, according to results of a large international trial.

In the study of 1,125 patients with advanced non-small-cell lung cancer, those given the combination treatment lived an average of 11.3 months vs. 10.1 months for those who only received chemotherapy.

Looked at another way, 47% of those given Erbitux plus chemotherapy were alive a year later, compared with 42% of those who only received chemotherapy.

The results set a new standard of care for the initial treatment of patients with non-small-cell lung cancer, says researcher Robert Pirker, MD, of the Medical University of Vienna in Austria.

Pirker presented the findings at the annual meeting of the American Society of Clinical Oncology.

Targeted Therapy for Lung Cancer

Lung cancer is the leading cancer killer, taking the lives of more than 160,000 Americans last year, according to the American Cancer Society. Non-small-cell lung cancer is the most common type of lung cancer, accounting for more than 80% of cases.

About four in 10 of cases of non-small-cell lung cancer are diagnosed at an advanced stage, when they have already spread to other parts of the body and are notoriously difficult to treat. Only about 15% of patients are alive five years after diagnosis.

Currently, the only targeted therapy that is approved as an initial therapy for these patients is Avastin. The study that led to that's drug's approval showed it extended their lives by about eight weeks.

But patients with certain tumor types, such as those with squamous cell cancer, were excluded from that trial, Pirker says. And as many as 30% of non-small-cell lung cancers fall into that category.

In contrast, Erbitux "was studied in people with all subtypes of cancer. In other words, we had a patient population that better reflects real life," he tells WebMD.

Erbitux is a monoclonal antibody that blocks the effects of a protein called epidermal growth factor that fuels tumor growth. It's already approved for treating head and neck as well as colorectal cancers.

Avastin works differently, preventing tumors from growing new blood vessels, thereby choking them to death. It is approved to treat metastatic breast cancer as well as late-stage colorectal cancer and late-stage lung cancer.

"Erbitux opens up a new choice for a sizable group of patients" for whom there are currently no real options, Pirker says.

The most common side effect associated with Erbitux was an acne-like rash. Moderate rash was observed in 10% of patients taking Erbitux vs. less than 1% of those on chemotherapy alone.

New Option for Lung Cancer Patients

Almost every doctor questioned by WebMD agreed the findings will change the way doctors treat patients with advanced non-small-cell lung cancers.

"An extra five weeks [of survival] might not seem like much, and it's not," says David M. Johnson, MD, deputy director of the Vanderbilt-Ingram Cancer Center in Nashville and a cancer survivor himself.

"But if you focus on the five weeks, you're losing the bigger message," he tells WebMD. "This is a positive study for a very tough group of patients to treat. Just like the Wright brothers didn't launch the 747 at Kitty Hawk, cancer cures aren't discovered overnight."

Before chemotherapy was introduced, only 10% of lung cancer patients could be expected to be alive a year later. Over the past 30 years, that figure jumped to 20%, and then to 30% as new chemotherapy agents were discovered, he says.

Now, with targeted therapies, Johnson says, "We can start telling our patients they have a nearly 50% chance of being alive in 12 months. I can guarantee you that a patient on Erbitux who is alive a year after diagnosis will tell you this drug is a true advance."

Howard Sandler, MD, professor of radiation and oncology at the University of Michigan, says, "This study has the potential to cause a major change in therapeutic practice, especially for patients who are ineligible for Avastin."

Sandler says that until a head-to-head study pitting Avastin against Erbitux is performed, "I can't say one is worse or better. People could say Avastin extended survival a few weeks more than Erbitux, but that is just not fair. Each showed a survival benefit. Ultimately, the choice will be up to physicians and patients," he says.

Roy Herbst, MD, chief of thoracic oncology at University of Texas M.D. Anderson Cancer Center in Houston, wasn't quite as enthusiastic. "It's a very small benefit," he says.

But Herbst acknowledges that it does offer a new option for Avastin-ineligible patients.

Almost all doctors agree the findings will lead to FDA approval of Erbitux for use in patients with advanced non-small-cell lung cancer.

Erbitux is made by ImClone Systems Inc. and marketed by Merck in Europe, which funded the study.

A spokesperson for ImClone Systems says the therapy will cost about $8,000. Johnson says Avastin is a little less expensive, "about $5,000 to $6,000."

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Sources

SOURCES:

American Society of Clinical Oncology 44th Annual Meeting, Chicago, May 30-June 2, 2008.

Robert Pirker, MD, Medical University of Vienna, Austria.

David M. Johnson, MD, deputy director, Vanderbilt-Ingram Cancer Center, Nashville, Tenn.

Howard Sandler, MD, professor of radiation and oncology, University of Michigan, Ann Arbor.

Roy Herbst, MD, chief of thoracic oncology, University of Texas M.D. Anderson Cancer Center, Houston.

American Cancer Society: "Cancer Facts & Figures."

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