Patient case: 50-year-old female with Lung cancer. Genetic variant: EGFR (L858R). Other conditions: Lupus.

Clinical trial: Erlotinib as First-line Treatment of Advanced Non-small Cell Lung Cancer (NSCLC) for Patients Unfit for Chemotherapy

Summary: A phase II study of Tarceva (Erlotinib) and predictive markers as first-line treatment of advanced non-small cell lung cancer for patients unfit for chemotherapy (NSCLC) Clinical Phase II Stage IIIB or IV non-small cell lung cancer (NSCLC) Primary end point: Disease control rate (= CR+PR and SD at 8 weeks /patients). Secondary end point: Safety (Serious Adverse Events, Adverse Events leading to premature withdrawal, unexpected TarcevaTM related AEs) .Correlation of EGFR expression rate (HER1) and FISH potentially predictive for response.
  An open-label, non randomized, multicenter, clinical trial of TarcevaTM as single agent The sample size is 29 patients in 2 stages and based on Simon´s optimal 2 stage design. Stage 1 will accrue 10 patients, if less than 1 response is observed the study will stop; if more than 1 response is observed the accrual will continue up till 29 patients. A total of 29 patients would be entered and the treatment will be declared to have sufficient activity to deserve further attention if at least 5 patients obtain disease control.


Eligibility: Inclusion Criteria:
  -  Histological or cytological documented diagnosis of inoperable, locally advanced, recurrent or metastatic (Stage IIIB or Stage IV) NSCLC.
  -  Chemo-naïve patients.
  -  Patients who are in the investigator's opinion not medically suitable for chemotherapy.
  -  Measurable disease according to the RECIST criteria.
  -  ECOG performance status of 0 - 3.
  -  Life expectancy of at least 12 weeks.
  -  Patients must be able to take oral medication.
  -  Serum calcium within normal ranges
  -  ≥ 4 weeks since prior surgery or radiation therapy
  -  For all females of childbearing potential a negative pregnancy test must be obtained within 48 hours before starting therapy and must use effective contraception
  -  18 years of age or older
  -  Written (signed) Informed Consent to participate in the study
  Exclusion Criteria:
  -  Prior systemic antitumor therapy
  -  Any unstable systemic disease which according to the investigator contraindicates the use of the study drug render the subject at high risk from treatment complications (including active infection, unstable angina, myocardial infarction within the previous month, inflammatory bowel disease, hepatic disease with serum bilirubin ≥ 2 upper limit of normal (ULN) or AST and/or ALT ≥ 2 x ULN (or ≥ 5 x ULN if clearly attributable to liver metastasis), renal disease with acute renal failure or serum creatinine ≥ 5 x ULN.
  -  Any other malignancies within 5 years (except for adequately treated carcinoma in situ of the cervix or basal or squamous cell skin cancer).
  -  Nursing mothers or pregnant woman.
  -  Hypersensitivity to Tarceva or co-formulants.
  -  Patients with brain metastasis or spinal cord compression that has not yet been definitively treated with surgery and/or radiation.
  -  Patients with brain metastasis or spinal cord compression that not are in a stable condition despite treatment with steroids.

Relevance to patient case: possibly relevant