Patient case: 50-year-old male with non-small cell lung cancer; genetic feature: EGFR (T790M)

Clinical trial: Gefitinib in Treating Patients With Stage IIIA Non-Small Cell Lung Cancer

Summary: RATIONALE: Gefitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving Gefitinib before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.
  PURPOSE: This phase II trial is studying how well gefitinib works in treating patients with stage IIIA non-small cell lung cancer.

Detailed description: OBJECTIVES:
  Primary
  -  To assess the response rate to gefitinib treatment as preoperative induction therapy in patients with biopsy-proven stage IIIA (pN2) non-squamous non-small cell lung cancer accompanied by epidermal growth factor receptor (EGFR) mutations.
  Secondary
  -  To determine the complete resection rate in patients treated with this drug.
  -  To determine the overall survival rate in patients treated with this drug.
  -  To determine the disease-free survival rate in patients treated with this drug.
  -  To determine the pathologic complete response rate in patients treated with this drug.
  -  To determine the toxicity of this drug in these patients.
  OUTLINE: This is a multicenter study.
  Patients receive oral gefitinib once a day on days 1-28. Treatment repeats every 28 days for up to 2 courses in the absence of disease progression or unacceptable toxicity.
  After completion of study treatment, patients with resectable disease may undergo surgery. Patients with unresectable disease may undergo surgery, chemotherapy, and/or radiotherapy.
  After completion of study therapy, patients are followed for 2 years.

Eligibility: DISEASE CHARACTERISTICS:
  -  Biopsy-proven stage IIIA nonsquamous non-small cell lung cancer
  -  pN2 disease proven by mediastinoscopy
  -  Meets any of the following criteria:
  -  Never smoked
  -  EGFR mutations (in exon 18, 19, or 21)*
  -  FISH positive for EGFR* NOTE: *Irrespective of smoking history
  -  Presence of at least 1 unidimensionally measurable lesion on thoracic CT scan, according to RECIST
  -  Feasible to undergo pneumonectomy or lobectomy
  PATIENT CHARACTERISTICS:
  Inclusion criteria:
  -  ECOG performance status 0-1
  -  FEV_1 ≥ 2.0 L in preoperative pulmonary function test
  -  Hemoglobin ≥ 9.0 g/dL
  -  WBC 4,000-12,000/μL
  -  ANC ≥ 1,500/μL
  -  Platelet count ≥ 100,000/mm³
  -  Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
  -  Alkaline phosphatase ≤ 3.0 times ULN
  -  AST and ALT ≤ 3.0 times ULN
  -  Creatinine ≤ 1.5 times ULN
  -  Negative pregnancy test
  Exclusion criteria:
  -  Severe complications or infections
  -  Pregnant or breast-feeding women
  -  Clinically significant heart disease
  -  Uncontrolled hepatitis, chronic liver disease, or diabetes mellitus
  -  Another active cancer except properly treated carcinoma in situ of the cervix or basal/squamous cell skin carcinoma
  PRIOR CONCURRENT THERAPY:
  -  No prior radiotherapy, chemotherapy, hormone therapy, or target therapy
  -  No other concurrent systemic anticancer therapies, including experimental drugs, chemotherapy, immunotherapy, or radiotherapy

Relevance to patient case: possibly relevant