[Tyrosine kinase inhibitors in the management of non-small cell lung cancer].
The epidermal growth factor receptor (EGFR) plays an important role in non-small cell lung cancer growth. Small molecules can specifically target the tyrosine kinase activity of the EGFR's intracellular domain and thus inhibit downstream pathways influencing cell proliferation and survival. Gefitinib and erlotinib have been developed as single-agents for the treatment of patients who have relapsed following one or more courses of chemotherapy. Erlotinib has exhibited significant overall survival benefit in a second- or third-line setting compared to placebo for unselected patients. A beneficial effect on survival has been observed in almost all subgroups of patients and the response rate was higher in women, non-smokers, Asian patients and patients with adenocarcinoma. Somatic mutations in the tyrosine kinase domain of EGFR have been shown to be strong predictive markers for drug response to gefitinib or erlotinib and led to a new insight into adenocarcinoma carcinogenesis. High EGFR gene copy number seems to be predictive of EGFR tyrosine kinase inhibitors-related effect on survival observed in second- or third-line treatment. Future use of EFGR tyrosine kinase inhibitors should be based on improved clinical and molecular selection of patients who are likely to derive the greatest benefit from these drugs, especially in first-line setting.
Pérol
M
M
Service de Pneumologie, Unité d'Oncologie Thoracique, Hôpital de la Croix-Rousse, Lyon cedex, France. maurice.perol@chu-lyon.fr
Arpin
D
D
D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*
D066246:ErbB Receptors; D011505:Protein-Tyrosine Kinases