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A Randomized Trial

Mark G. Kris, MD; Ronald B. Natale, MD; Roy S. Herbst, MD; Thomas J. Lynch, Jr, MD; Diane Prager, MD; Chandra P. Belani, MD; Joan H. Schiller, MD; Karen Kelly, MD; Harris Spiridonidis, MD; Alan Sandler, MD; Kathy S. Albain, MD; David Cella, PhD; Michael K. Wolf, PhD; Steven D. Averbuch, MD; Judith J. Ochs, MD; Andrea C. Kay, MD

JAMA. 2003;290:2149-2158.

Context  More persons in the United States die from non–small cell lung cancer (NSCLC) than from breast, colorectal, and prostate cancer combined. In preclinical testing, oral gefitinib inhibited the growth of NSCLC tumors that express the epidermal growth factor receptor (EGFR), a mediator of cell signaling, and phase 1 trials have demonstrated that a fraction of patients with NSCLC progressing after chemotherapy experience both a decrease in lung cancer symptoms and radiographic tumor shrinkages with gefitinib.

Objective  To assess differences in symptomatic and radiographic response among patients with NSCLC receiving 250-mg and 500-mg daily doses of gefitinib.

Design, Setting, and Patients  Double-blind, randomized phase 2 trial conducted from November 2000 to April 2001 in 30 US academic and community oncology centers. Patients (N = 221) had either stage IIIB or IV NSCLC for which they had received at least 2 chemotherapy regimens.

Intervention  Daily oral gefitinib, either 500 mg (administered as two 250-mg gefitinib tablets) or 250 mg (administered as one 250-mg gefitinib tablet and 1 matching placebo).

Main Outcome Measures  Improvement of NSCLC symptoms (2-point or greater increase in score on the summed lung cancer subscale of the Functional Assessment of Cancer Therapy-Lung [FACT-L] instrument) and tumor regression (>50% decrease in lesion size on imaging studies).

Results  Of 221 patients enrolled, 216 received gefitinib as randomized. Symptoms of NSCLC improved in 43% (95% confidence interval [CI], 33%-53%) of patients receiving 250 mg of gefitinib and in 35% (95% CI, 26%-45%) of patients receiving 500 mg. These benefits were observed within 3 weeks in 75% of patients. Partial radiographic responses occurred in 12% (95% CI, 6%-20%) of individuals receiving 250 mg of gefitinib and in 9% (95% CI, 4%-16%) of those receiving 500 mg. Symptoms improved in 96% of patients with partial radiographic responses. The overall survival at 1 year was 25%. There were no significant differences between the 250-mg and 500-mg doses in rates of symptom improvement (P = .26), radiographic tumor regression (P = .51), and projected 1-year survival (P = .54). The 500-mg dose was associated more frequently with transient acne-like rash (P = .04) and diarrhea (P = .006).

Conclusions  Gefitinib, a well-tolerated oral EGFR-tyrosine kinase inhibitor, improved disease-related symptoms and induced radiographic tumor regressions in patients with NSCLC persisting after chemotherapy.

Author Affiliations: Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center and the Weill Medical College of Cornell University, New York, NY (Dr Kris); Cedars-Sinai Comprehensive Cancer Center, Los Angeles, Calif (Dr Natale); University of Texas M. D. Anderson Cancer Center, Houston (Dr Herbst); Massachusetts General Hospital Cancer Center, Boston (Dr Lynch); UCLA Medical Center, Los Angeles, Calif (Dr Prager); University of Pittsburgh Cancer Institute, Pittsburgh, Pa (Dr Belani); University of Wisconsin Hospital, Madison (Dr Schiller); University of Colorado Health Sciences Center, Denver (Dr Kelly); Hematology Oncology Consultants Inc, Columbus, Ohio (Dr Spiridonidis); Vanderbilt University, Nashville, Tenn (Dr Sandler); Loyola University Medical Center, Maywood, Ill (Dr Albain); Northwestern University, Evanston, Ill (Dr Cella); AstraZeneca Pharmaceuticals, Wilmington, Del (Drs Wolf, Averbuch, Ochs, and Kay).

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