The role of gefitinib in the management of Asian patients with non-small cell lung cancer

Background: Lung cancer is the most common cause of death in cancer patients worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer cases. The prognosis of NSCLC is still poor, albeit slow and steady improvement achieved in the past three decades by chemotherapy. Recently, the importance of epidermal growth factor receptor (EGFR) in the pathogenesis and progression in NSCLC was identified particularly in those cancer cells with EGFR mutation and/or increased gene copy number. Gefitinib, an EGFR tyrosine kinase inhibitor, was the first agent approved for treating advanced NSCLC. It has become a popular choice in treating Asian patients after a higher response rate was reported in Japanese patients than in non-Japanese patients in the first Phase 11 trial. Objective: To evaluate the role of gefitinib in the treatment of Asian patients with NSCLC. Methods: A review of published papers in PubMed and Embase (2000 - 2007) and meeting reports of the American Society of Clinical Oncology and World Conference on Lung Cancer (2000 - 2007) was carried out. Results/conclusions: In general, gefitinib is well tolerated. As the second- or third-line treatment, gefitinib has proven survival benefits in Asian patients with advanced NSCLC, when compared with placebo. It has equivalent efficacy to docetaxel with less toxicity as the second-line therapy. As the first-line therapy, it yielded encouraging results but its final role is pending on the results of the ongoing randomised Phase III trial. Gefitinilb should be considered as the treatment of choice for second- or third-line therapy in advanced NSCLC in Asian patients after progression from previous chemotherapy. Its role as the first-line, adjuvant or neoadjuvant therapy remains to be determined.