How should cetuximab be incorporated into first-line therapy?
Cetuximab has shown consistent but modest activity in lung cancer when combined with chemotherapy. Data from the FLEX trial support the use of cetuximab when given with cisplatin and vinorelbine as first-line treatment,40 and cetuximab is a reasonable option for chemonaive patients with stage IV NSCLC. Supportive data (in terms of response rate) have been obtained in trials of cetux imab combined with taxanes and gemcitabine,133,135 but these results have not clarified whether cetuximab can prolong survival. (The gemcitabine- based regimen was a randomized phase II, and survival data have not yet reported for the trial using taxanes.) Given that the one trial with a survival advantage used EGFR IHC testing, many feel that use of cetuximab should be restricted to patients with IHC-positive tumors. The hope is that cetuximab, like bevacizumab, eventually will find wide application for multiple chemotherapy platforms in NSCLC.
