Abstract
The continuation of an active therapeutic agent for extended duration following frontline induction chemotherapy as maintenance therapy can improve overall survival. The Gemtax IV trial compares a platinum-containing doublet vs. a platinum-free sequential chemotherapy with docetaxel and gemcitabine, both arms in combination with cetuximab until progression. However, a useful predictive marker for maintaining an EGFR antibody treatment still not exists.
We report about a 56-year-old female Caucasian patient with multiple pulmonary lesions and diagnosis of a bronchioloalveolar carcinoma. She was at good performance status (ECOG 0), without relevant comorbidities with a smoking history of 35 packyears. EGFR mutation analysis showed an insertion in exon 20 of the EGFR-gene. Within the Gemtax IV trial 4 cycles of carboplatin/gemcitabine/cetuximab were given. Toxicity was a grade III neutropenia and a grade I rash without itching. A total number of 16 cycles cetuximab were completed until therapy was stopped on patient's request. After six weeks, tumor progression was documented, resulting in a PFS of 12.5 months. In the course, the patient did benefit from another chemotherapy, but not from an EGFR-TKI (erlotinib). OS was 32 month.
In our case a rapid tumor progression was seen after stopping cetuximab maintenance therapy. This could indicate a significant antitumor activity of the EGFR antibody in this patient. Biomarkers or clinical selection criteria should be identified that allow to predict patients benefit from cetuximab maintenance therapy and avoid such “rebound phenomenon” or unneeded maintenance treatment.
- © 2011 ERS
