A Welcome Skin Rash

Lung cancer patients live longer if rash develops after treatment

(RxWiki News) For most people, getting a rash would not be good news. For elderly patients with advanced non-small cell lung cancer, however, a rash may indicate a likelihood of living longer.

Erlotinib (brand name Tarceva) is a drug commonly prescribed to treat advanced non-small cell lung cancer (NSCLC).

A new study finds that elderly NSCLC patients who develop a rash after receiving the medication survive slightly longer than those who did not develop the rash.

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Siow Ming Lee, MD, PhD, professor of medical oncology at University College London (UCL) and clinical researcher for Cancer Research UK at the UCL Cancer Institute, and his colleagues analyzed data on 670 NSCLC patients from 78 hospitals around the United Kingdom. Researchers randomly assigned 350 patients to receive erlotinib and 320 to receive a placebo.

The majority of the patients were over the age of 75. About eight in 10 cases of this form of lung cancer occur in people who are age 60 or older, according to Cancer Research UK. The average age for NSCLC patients in the United Kingdom is 72.

Patients who developed a painless rash within 28 days of receiving erlotinib survived an average of 6.2 months compared with 4.1 months for those who were given a placebo.

According to Dr. Ming Lee, the rash signals a patient is benefiting from the drug treatment, and six out of ten patients who received erlotinib developed the rash.

In addition, scientists found that patients lived even longer if they had mutations in epidermal growth factor receptors (EGFR), as well as the rash. Altered EGFRs on the surface of cancer cells have often been observed in NSCLC patients. Erlotinib is an EGFR inhibitor.

Patients with both the genetic mutation and a rash lived an average of more than 10.4 months.

Dr. Ming Lee also noted women with the rash tend to live longer than men, and smokers were less likely to develop the rash than nonsmokers.

A study from the National Cancer Institute of Canada using data from 2007 found adding erlotinib to NSCLC treatment costs about $95,000 for each year of life gained. 

Because NSCLC patients are often elderly, they can be frail and have medical conditions that make them unsuitable for chemotherapy. Erlotinib may provide an effective alternative.

“We hope these important trial results will in future mean more people can benefit from the valuable extra months of life that erlotinib can bring some patients, who would otherwise have very few treatment options,” said Liz Woolf, head of Cancer Research UK’s patient information website, CancerHelp UK.

Dr. Ming Lee added, “This [research] is extremely encouraging and represents a significant step forward for this group of patients, who often only have a short time left to live.”

As far as next steps are concerned, Dr. Ming Lee said further studies are urgently needed to understand the link between skin rash and erlotinib response in order to find ways of exploiting this relationship for maximum benefit.

The study was published in October in Lancet Oncology. Funding was provided by Cancer Research UK and Roche, the manufacturer of Tarceva.

Review Date: 
October 30, 2012