Elsevier

Lung Cancer

Volume 40, Issue 1, April 2003, Pages 73-76
Lung Cancer

Case report
Dramatic effect of ZD1839 (‘Iressa’) in a patient with advanced non-small-cell lung cancer and poor performance status

https://doi.org/10.1016/S0169-5002(03)00028-XGet rights and content

Abstract

We describe the case of a 52-year-old Japanese woman with advanced adenocarcinoma of the lung, in whom once-daily treatment with 250 mg ZD1839 (‘Iressa’) demonstrated a marked antitumour effect. She had initially achieved a partial response with cisplatin-based combination chemotherapy, but had subsequently progressed and had failed to respond to salvage chemotherapy. She had also received whole-brain irradiation for brain metastases. On admission, the patient was confined to bed due to dyspnoea and had rapidly progressing hypoxia secondary to lymphangitis carcinomatosa and a massive right pleural effusion. She was treated with oxygen supplementation and oral ZD1839, which, within a week, led to marked tumour regression and gradually improving dyspnoea. The main adverse event observed was a grade 2 rash. A month after starting ZD1839 treatment, the patient was discharged without the need for oxygen supplementation and had since returned to full-time work. This is a demonstration of ZD1839 producing a dramatic clinical response when administered to a patient with poor performance status who had received extensive prior treatment with cytotoxic agents.‘Iressa’ is a trademark of the AstraZeneca group of companies.

Introduction

ZD1839 (‘Iressa’) is an orally active, selective epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that blocks signal transduction pathways implicated in promoting cancer growth, leading to decreased cellular proliferation, angiogenesis, tumour invasion and metastasis, and increased apoptosis [1]. ZD1839 is the most advanced of the EGFR-targeted drugs in clinical development, and, in phase I studies, has shown evidence of antitumour activity in advanced non-small-cell lung cancer (NSCLC) [2], [3], [4], [5]. These initial results have been supported by recently reported data from a phase II study (IDEAL 1) in patients with advanced NSCLC who had received one or two prior chemotherapy regimens, at least one of which was platinum-based: the response rate was 18.4% (95% confidence interval [CI]: 11.0–25.9%) and the disease control rate (response+stable disease) was 54.4% (95% CI: 36.0–55.3%) in patients receiving ZD1839 250 mg/day [6]. Symptom improvement was seen in 40.3% (95% CI: 28.6–52.0%) of patients at 250 mg/day and the median time to symptom improvement was 8 days [7]. Additionally, in a second phase II study (IDEAL 2), in patients with advanced NSCLC who had previously received two or more chemotherapy regimens containing platinum and docetaxel given either concurrently or separately, the response rate was 11.8% (95% CI: 6.2–19.7%) and the symptom improvement rate was 43% for patients receiving ZD1839 250 mg/day [8]. In both trials, the majority of adverse events were mild, and grade 3/4 events were rare with the 250 mg/day dose [6], [8].

In this paper, we report the case of a patient with advanced NSCLC and a poor performance status who had a marked response to ZD1839.

Section snippets

Case report

A 52-year-old Japanese woman was admitted, by ambulance, to our hospital on 15 November 2001.

Discussion

A patient who was dying of progressive dyspnoea due to advanced NSCLC with cerebral metastases showed a marked improvement following ZD1839 therapy. This is the most remarkable effect we have ever seen in a patient with refractory advanced NSCLC.

This case highlights some important points related to ZD1839 therapy for NSCLC. Firstly, ZD1839 can be administered to patients with poor performance status. Secondly, this patient had been very heavily pretreated, and ZD1839 did not show

Acknowledgements

We thank Professor Masahiro Fukuoka (4th Department of Internal Medicine, Kinki University School of Medicine, Osaka, Japan) for his excellent advice in treating this patient.

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